Case Question about ERCP coding?

Discussion in 'Medical Coding & Reimbursement Discussion' started by Becky Curtis, Feb 1, 2013.

  1. Becky Curtis

    Becky Curtis Member

    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. :)
     
  2. Laureen

    Laureen Queen Instructor Staff Member Administrator Moderator MTA Student Replay Cluber PPM Student (CPPM®) PBC Student (CPC®) Blitzer CCO Support Staff FBC Student (CPC-H®) ICD-10-CM Student

    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.
     
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  3. Becky Curtis

    Becky Curtis Member

    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.
     
  4. lori woods

    lori woods Well-Known Member CCO Practicoder

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

    Luna Well-Known Member Replay Cluber PBC Student (CPC®) Blitzer FBC Student (CPC-H®)

    Something tells me it may be codes 43262 , 43265, & 43245 ?
     
  6. Carolyn Heath

    Carolyn Heath Well-Known Member Replay Cluber CCO Practicoder

    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.
     
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  7. Laureen

    Laureen Queen Instructor Staff Member Administrator Moderator MTA Student Replay Cluber PPM Student (CPPM®) PBC Student (CPC®) Blitzer CCO Support Staff FBC Student (CPC-H®) ICD-10-CM Student

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

    Using supercoder to look up my codes:

    [​IMG]

    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


    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.

    [​IMG]

    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 :eek: We need to code from the ERCP bubble not the UGI bubble.
     
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  8. Laureen

    Laureen Queen Instructor Staff Member Administrator Moderator MTA Student Replay Cluber PPM Student (CPPM®) PBC Student (CPC®) Blitzer CCO Support Staff FBC Student (CPC-H®) ICD-10-CM Student

    And here is as a video explanation

     
  9. Becky Curtis

    Becky Curtis Member

    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.
     
  10. Laureen

    Laureen Queen Instructor Staff Member Administrator Moderator MTA Student Replay Cluber PPM Student (CPPM®) PBC Student (CPC®) Blitzer CCO Support Staff FBC Student (CPC-H®) ICD-10-CM Student

    Yes that is my thinking.
     

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