AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2025 Issue 4; Ask the Editor

Biliary Drainage Using the AXIOS™ Stent

A patient with elevated liver enzymes and jaundice was admitted for an upper endoscopic ultrasound. An obstructive mucosal polyp involving the major papilla was identified. The decision was made to create a choledochoduodenostomy using the AXIOS™ lumen-apposing metal stent (LAMS) system to achieve biliary drainage. A 19-gauge needle was used to puncture both the duodenal wall and the bile duct under endosonographic guidance. Bile was aspirated, and the cyst was filled with contrast to obtain a cystogram via fluoroscopy. The AXIOS™ stent and an electrocautery device were introduced through the working channel and advanced over the guidewire. The cautery tip was activated to enlarge the stoma. The AXIOS™ device was then advanced into the bile duct, and a 6 x 8 mm AXIOS™ stent was positioned with its flanges closely approximated to the walls of both the bile duct and duodenum through the choledochoduodenostomy. What root operation is appropriate for this procedure, Bypass or Drainage? ...

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