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ERCP with a snare

  1. #1
    Default ERCP with a snare
    Medical Coding Books
    Please read the note below. Would I be able to use the 43251 code for the snare? I have the 43262, 43258 but am not sure about the code for the snare. I do not see anything in the CCI Edits about using this code with the ERCP codes but I want to see if anyone else has ever coded this procedure before. Any help would be appreciated. Thanks a million!

    ---------------------------------

    PROCEDURE PERFORMED: Endoscopic retrograde cholangiopancreatography with
    ampullectomy.

    INDICATIONS: History of familial adenomatous polyposis with ampullary
    adenomatous polyp identified. The patient had undergone an endoscopic
    ultrasound that showed an intact muscularis propria.

    INSTRUMENT: Olympus ERCP endoscope.

    MEDICATIONS: Demerol 150 mg IV, Versed 7 mg, Phenergan 25 mg IV.

    COMPLICATIONS: None.

    TECHNIQUE: Informed consent was obtained from the patient. The patient was
    placed in the prone position. Conscious sedation was administered as
    above. The endoscope was passed through the mouth and advanced to the
    second portion of the duodenum. The ampulla was identified and appeared
    polypoid with adenoma that measured about 1 cm. The scope was advanced
    into the pancreatic duct and the pancreatogram was normal. A snare was
    then used to encircle the polyp and cautery applied to completely resect
    the ampulla. This was then retrieved with a Roth net and specimens sent to
    pathology.

    FINDINGS: Normal appearing common bile duct and pancreatic duct. No
    filling defects were identified. An adenomatous polyp that measured about
    1 cm was seen. This was resected using the snare cautery polypectomy. The
    specimen was completely resected and the sample sent of the specimen to
    pathology. A small biliary sphincterotomy was performed. A 5-French x 5
    cm prophylactic pancreatic stent was placed in good position.

    IMPRESSION: As above. Complete resection of ampullary adenoma. Normal
    common bile duct and pancreatic duct on endoscopic retrograde
    cholangiopancreatography. A 5-French prophylactic pancreatic duct stent
    placed.
    JOJO-CPC-H

  2. #2
    Location
    Lauderdale Lakes
    Posts
    203
    Default
    I only see 43261, the removal of the polyp, and the 43268, insertion of stent. the 43258 is an ablation of the tumor. He did not do that. The 43251 is and EGD not an ERCP. The ERCP codes start at 43260.

  3. #3
    Default
    Oops, I meant to say 43268, not 43258 . Also, I thought 43261 was biopsy only not polyp removal (snare). Thanks for your help!. I appreciate your feedback.
    JOJO-CPC-H

  4. #4
    Location
    Lauderdale Lakes
    Posts
    203
    Default
    I didnt see a code for ERCP with Snare so I thought the one with biopsy was the closest match. The op note did say they sent the polyp out for biopsy. This is how I would have billed it.

  5. #5
    Location
    Pensacola, Florida
    Posts
    275
    Default
    We use an unlisted for a snare ampullectomy - 44799

  6. #6
    Default
    Thanks everyone. We learn something new everyday.
    JOJO-CPC-H

  7. #7
    Default Ercp
    In this case, I would use 43261 , 43262, 43268, 43273
    I don't see documentation for the cannulations of the bile and/or pancreatic
    ducts.... get your docs to document the cannulations so that you can capture
    the professional components of 74328, 74329, 74330... these take a -26 modifier.

    Mary Jo Russman, BA, CPC, CGIC, CMC
    Cleveland Clinic
    Digestive Disease Institute

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