Case Question about ERCP coding?

[Becky Curtis]

I saw a post on our local chapter board asking how to code for a ERCP with stone extraction and sphincterotomy, the doctor also reported doing a balloon dilation of the pylorus? The person who posted the question had found the codes for ERCP with stone extraction and sphincterectomy but was having trouble with the balloon dilation. What would the code be? I have an idea but want to know if I am right.

 

[Laureen]

The instructor in me says "tell us what you think it is and we'll let you know if you're right" ;-) Don't be shy.

 

[Becky Curtis]

I knew that response was coming. I will try and post out my thoughts tomorrow. My current job has kept me really busy the past several days.
Thanks.

 

[Lori Woods]

I googled this & came up with 43245 CPT & 537.0 ICD-9.

 

[Luna]

Something tells me it may be codes 43262 , 43265, & 43245 ?

 

[Carolyn Heath]

I agree with Lori Woods. It is 43245 for the CPT code and 537.0 for the ICD-9 code. I used the google search and looked at Supercoder to find the codes.

 

[Laureen]

how to code for a ERCP with stone extraction and sphincterectomy, the doctor also reported doing a balloon dilation of the pylorus

So I see three types of ERCP procedures here
1) stone extraction
2) sphincterectomy
3) balloon dilation

Using supercoder to look up my codes:

For #1 43264 fits the bill "Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde removal of calculus/calculi from biliary and/or pancreatic ducts" It also has this parenthetical note
Notes:
(When done with sphincterotomy, also use 43262)

So for #2 I like 43262 Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy

And for #3 you might be tempted to use 43271 "Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde balloon dilation of ampulla, biliary and/or pancreatic duct(s) " but is does not say of the pyloris. Here is an excerpt from a supercoder article

The use of a balloon to remove stones should not be confused with the balloon dilation of the ampulla, biliary or pancreatic ducts, which is a separate procedure reported with code 43271 (ERCP with endoscopic retrograde balloon dilation of ampulla, biliary and/or pancreatic ducts). Ductal dilation is done when there is a stricture of one of the ducts, says Minocha. Even the balloons used for the two procedures are different. For the stones themselves, no ductal dilation is done.

Perhaps some anatomy review will help. If there was a stricture where the blue arrows were you could code 43271 but the part where the scope is curving around is the pylorus - if that is being widened to get to the stone that is bundled in.

So my final answer is

43264 and 43262

Note to our CCO Students:
You can't use 43245 because that is an UGI code. When you get to the lessons on the digestive system in the course you'll see that you were in the right pew but the wrong church We need to code from the ERCP bubble not the UGI bubble.

 

[Laureen]

And here is as a video explanation

 

[Becky Curtis]

Thank you Laureen for answering this question. I only have access to my CPT 2012 book since I am certified and still searching for a coding job. However, you answered my question. I found the 43245 code but did not think it was correct since it was in the wrong section for the procedure even though it did mention balloon dilation of the pylorus.

Since I did not see the actual doctor's report I have no way of knowing, but from what you described it sounds like the balloon dilation of the pylorus may have been done to aid with the removal of the stones therefore would have been covered by the 43264 code.

 

[Laureen]

Yes that is my thinking.