sksmith31
Contributor
Can someone tell me if I can code both 43277 & 43274? I just started coding these.
Informed consent was given. The patient was sedated, intubated, and placed in a semi-prone position on the fluoroscopy table. The duodenoscope was advanced under direct visualization through the mouth to the second portion of the duodenum. The ampulla was identified. The ampulla appeared inflammed. Deep biliary cannulation was achieved with some difficulty using a Boston Scientific sphincterotome. The guidewire was contacting firm tissue just proximal to the ampulla. Partial cannulation was achieved and a sphincterotomy was performed to facilitate deep cannulation. The maneuver was successful. A cholangiogram was performed, and revealed a smooth, dilated duct. No contrast was filling the distal duct. A 4 cm x 8 mm dilating balloon was used to dilate the distal duct and ampulla up to 8 mm successfully. There was a waste initially, which nearly resolved with the dilation. A cytology brush and forceps were both used to attempt to collect some tissue to submit for pathology. Lastly, a 4 cm x 10 mm fully covered metal stent was placed across the stricture / possible pancreatic mass. The guidewire, catheter, and endoscope were withdrawn from the patient. The patient tolerated the procedure well and there were no complications.
Impression:
1) Biliary obstruction secondary to a stricture vs pancreatic tumor - biopsies taken
Informed consent was given. The patient was sedated, intubated, and placed in a semi-prone position on the fluoroscopy table. The duodenoscope was advanced under direct visualization through the mouth to the second portion of the duodenum. The ampulla was identified. The ampulla appeared inflammed. Deep biliary cannulation was achieved with some difficulty using a Boston Scientific sphincterotome. The guidewire was contacting firm tissue just proximal to the ampulla. Partial cannulation was achieved and a sphincterotomy was performed to facilitate deep cannulation. The maneuver was successful. A cholangiogram was performed, and revealed a smooth, dilated duct. No contrast was filling the distal duct. A 4 cm x 8 mm dilating balloon was used to dilate the distal duct and ampulla up to 8 mm successfully. There was a waste initially, which nearly resolved with the dilation. A cytology brush and forceps were both used to attempt to collect some tissue to submit for pathology. Lastly, a 4 cm x 10 mm fully covered metal stent was placed across the stricture / possible pancreatic mass. The guidewire, catheter, and endoscope were withdrawn from the patient. The patient tolerated the procedure well and there were no complications.
Impression:
1) Biliary obstruction secondary to a stricture vs pancreatic tumor - biopsies taken