AHA Coding Clinic® for HCPCS - 2013 Issue 3; Ask the Editor

Endoscopic ultrasound with transduodenal approach

Patient presents to have an endoscopic retrograde cholangiopancreatography (ERCP) due to pancreatic duct stones and abdominal pain. However, due to extensive edema of the duodenal wall and luminal narrowing of the second part of the duodenum, cannulation of the major papilla was not successful. Therefore, an endoscopic ultrasound (EUS) was performed. Images of the pancreas showed pancreatitis and stones. The duodenal wall was punctured with a 19-gauge needle to access the pancreatic duct via the duodenum (2nd portion). The pancreaticoduodenostomy was made and balloon dilation was performed. A pigtailed stent was placed in the main pancreatic duct. We are considering CPT code 48999, Unlisted procedure, pancreas, because of the transduodenal approach and 43260, Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, with or without collection of specimen(s) by brushing or washing, for the diagnostic ERCP with modifier 74, Discontinued outpatient hospital Ambulatory Surgery Center (ASC) procedure, after administration of anesthesia, appended. Is there a CPT code for EUS with transduodenal approach to the pancreatic duct with dilation, pancreaticoduodenostomy and stent placement?  ...

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