AHA Coding Clinic® for HCPCS - 2023 Issue 2; Ask the Editor

Endoscopic hepaticogastrostomy with stent

A patient with a bile duct obstruction presented for an upper GI endoscopic ultrasound. The endosonoscope was introduced through the mouth, and advanced to the second part of the duodenum. The examination found a large collection of peritoneal fluid and dilation of the left intrahepatic bile ducts. The decision was made to create a hepaticogastrostomy. Once an appropriate position in the stomach was identified, the common wall between the stomach and the left intrahepatic duct were punctured with a needle. The biliary tree was injected with contrast and a cholangiogram was obtained under fluoroscopy. A glidewire was threaded into the left intrahepatic duct. The hepaticogastrostomy opening was dilated with a 4 mm balloon, which was then followed by insertion of a biliary stent. Is creation of the hepaticogastrostomy coded separately from the stent insertion, or inherent to the stent placement? Which CPT code(s) is assigned for the stent insertion via hepaticogastrostomy? ...

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