suela923@aol.com
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Would you code 48102 or 49180 for this biopsy? Thanks! Sue
ULTRASOUND-GUIDED PANCREATIC BIOPSY
History:
Large pancreatic head mass. Prior endoscopic fine-needle aspiration
Technique:
Risks and benefits of the procedure were discussed with the patient and informed consent was obtained. The patient was placed supine on the angiographic table and the epigastric region was prepped and draped in the usual sterile fashion. Moderate sedation was begun and 2% lidocaine was administered for local anesthesia.
The upper abdomen was evaluated with ultrasound with acquisition of permanent images. Subsequently, a 20-gauge coaxial needle was advanced into the large pancreatic mass via a approach through the inferior aspect of the right hepatic lobe. Care was taken to avoid adjacent structures. Through this needle a total of 2 core biopsy specimens were obtained utilizing a 19-gauge core biopsy device. The needle was removed and post procedure images were obtained. The patient tolerated the procedure well and without immediate complication.
Limited grayscale ultrasound images of the abdomen revealed a large hypoechoic mass in the region of the pancreatic head. This is closely surrounded by the portal vein and bordered inferiorly by the superior mesenteric vein. No clear window was identified without intervening liver or gastrointestinal tract. An approach was taken through the inferior right lobe of the liver. The needle was advanced into the pancreatic mass inferior to the splenic vein and to the right of the portal and superior mesenteric veins. Core biopsy specimens were obtained. Post procedure images demonstrated no significant hemorrhage and no evidence of abnormal color flow surrounding the portal vein to suggest aneurysm formation.
Result Impression
Technically successful ultrasound-guided biopsy of a large pancreatic head mass via a transhepatic approach.
ULTRASOUND-GUIDED PANCREATIC BIOPSY
History:
Large pancreatic head mass. Prior endoscopic fine-needle aspiration
Technique:
Risks and benefits of the procedure were discussed with the patient and informed consent was obtained. The patient was placed supine on the angiographic table and the epigastric region was prepped and draped in the usual sterile fashion. Moderate sedation was begun and 2% lidocaine was administered for local anesthesia.
The upper abdomen was evaluated with ultrasound with acquisition of permanent images. Subsequently, a 20-gauge coaxial needle was advanced into the large pancreatic mass via a approach through the inferior aspect of the right hepatic lobe. Care was taken to avoid adjacent structures. Through this needle a total of 2 core biopsy specimens were obtained utilizing a 19-gauge core biopsy device. The needle was removed and post procedure images were obtained. The patient tolerated the procedure well and without immediate complication.
Limited grayscale ultrasound images of the abdomen revealed a large hypoechoic mass in the region of the pancreatic head. This is closely surrounded by the portal vein and bordered inferiorly by the superior mesenteric vein. No clear window was identified without intervening liver or gastrointestinal tract. An approach was taken through the inferior right lobe of the liver. The needle was advanced into the pancreatic mass inferior to the splenic vein and to the right of the portal and superior mesenteric veins. Core biopsy specimens were obtained. Post procedure images demonstrated no significant hemorrhage and no evidence of abnormal color flow surrounding the portal vein to suggest aneurysm formation.
Result Impression
Technically successful ultrasound-guided biopsy of a large pancreatic head mass via a transhepatic approach.