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Stent Removal - ERCP

  1. #1
    Default Stent Removal - ERCP
    Medical Coding Books
    Here is a copy of an actual note. I am thinking 43260, 997.4. Any help would be great.



    PROCEDURE PERFORMED: Endoscopic retrograde cholangiopancreatography
    )ERCP).


    INDICATIONS: This is an ------- female who initially came in with
    pancreatitis. Cholecystectomy and E.R.C.P. was done in October, 2010. The
    E.R.C.P. did not show any stones in the colon bile duct. A pancreatic duct
    stent was placed at that time prophylactically. After the cholecystectomy,
    the patient was found to have a bile leak. Subsequent E.R.C.P. in
    November, 2010 showed a bile leak. A bile duct stent was placed at that
    time, and sphincterotomy was done. The E.R.C.P. is done to remove the bile
    duct stents and to assess for presence of bile leak.

    REFERRING PHYSICIAN:

    INSTRUMENT:


    MEDICATIONS:
    Demerol 150 mg intravenously throughout the procedure.
    Versed 5 mg intravenously throughout the procedure.
    Phenergan 25 mg intravenously throughout the procedure.


    COMPLICATIONS: None.


    TECHNIQUE: The risks and benefits of the procedure were explained to the
    patient with the help of a interpreter. The patient signed an
    informed consent form. The patient was placed into the prone position.
    The E.R.C.P. scope was introduced through the mouth and advanced to the
    second portion of the duodenum. The bile duct previously placed CPD stent
    was removed with the snare. The common bile duct was cannulated and a
    cholangiogram was obtained. Standard monitoring was done throughout the
    procedure.


    FINDINGS:
    1. Previous sphincterotomy and previously placed common bile duct stent
    was visualized. The common bile duct stent was removed with the
    snare.
    2. The common bile duct was cannulated, and an cholangiogram was
    obtained. There was no evidence of extravasation of contrast. There
    were no strictures or filling defects in the common bile duct. The
    common bile duct was 9 mm in size. The intrahepatic ducts look
    normal.


    IMPRESSION:
    1. Previous sphincterotomy and previously placed common bile duct stent
    visualized. Common bile duct stent removed with a snare.
    2. No evidence of strictures filling the region of the common bile duct
    . No evidence of extravasation of contrast. Common bile duct 9 mm in
    size and intrahepatic duct is normal.


    RECOMMENDATIONS:
    1. Follow-up with primary care physician.
    2. Follow-up in gastroenterology clinic as needed
    JOJO-CPC-H

  2. Default
    Hi
    Check with 43269 -Common bile duct stent removal...

    Hope it Helps....

    Nalini CPC

  3. #3
    Location
    Pensacola, Florida
    Posts
    274
    Default
    43269. We typically list the reason for the stent placement in our ICD-9 codes as well.

  4. #4
    Default
    Thanks ladies but I thought the removal was included in the code for stent placement so you could not actually bill for the removal. I am very confused. Some say not to use 43269 because the stent is not technically a foreign body and some say to use it. Thanks for your responses, I appreciate your help.
    JOJO-CPC-H

  5. #5
    Default
    In this case 43269 would be appropriate however I would use the dx the reason for the stent placement (biliary leak).

  6. #6
    Default
    Thanks!
    JOJO-CPC-H

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