Question Endoscopic Biliary Rendezvous CPT


Saint Marys, WV
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Hello. I am looking for a procedure code to bill for an endoscopic transduodenal biliary stent placement. There was no percutaneous access, therefore 47541 would not be correct. Would I bill the regular ERCP w/ stent code 43274 or an unlisted of 47999? TIA!
"Because deep cannulation of the bile duct was not achieved and suspected to be impossible given degree of pre-existing congestion, preparations were made for a rendezvous maneuver. The duodenoscope was removed
and exchanged for a diagnostic echoendoscope, which was inserted. The extrahepatic bile duct was punctured using a 19 gauge needle under endosonographic and radiologic guidance through a transduodenal approach. Bile was aspirated. Next,
the bile duct was injected with contrast, and a cholangiogram was obtained under fluoroscopy. Contrast extended to the left and right intrahepatic bile ducts. The distal common bile duct was obstructed. A guidewire was passed anterograde through the needle and used successfully to traverse the obstruction. The end of the guidewire was passed into the duodenum. The echoendoscope was exchanged back for the duodenoscope. The duodenoscope was reinserted alongside the guidewire. Alongside the guidewire, the bile duct was deeply cannulated with the traction (standard) sphincterotome. A wire was passed into the biliary tree. The rendezvous guidewire was removed. The lower third of the main bile duct contained a single severe stenosis. The middle third of the main bile duct, upper third of the main bile duct and left and right hepatic ducts and all intrahepatic branches were diffusely dilated. An extension biliary sphincterotomy was made with a monofilament traction (standard) sphincterotome using ERBE electrocautery. There was no post-sphincterotomy bleeding. One 10 mm by 6 mm covered metal stent was placed into the common bile duct. Bile flowed through the stent. The stent was in good position."