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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Article Overview
This article explains a complex endoscopic approach to relieving biliary obstruction using an AXIOS™ lumen-apposing metal stent system. It is aimed at coders and clinical documentation staff who need to understand how the procedure is described, which specialties are involved, and how to think about the applicable procedural classification in ICD-10-PCS terms. The discussion centers on the anatomy involved, the endoscopic and fluoroscopic elements of the procedure, and the coding decision point raised by the case.
Why This Topic Matters
Procedures involving advanced endoscopic biliary access and stent placement can be difficult to classify correctly from operative documentation alone. Understanding the procedure context helps support accurate inpatient procedure coding and consistent interpretation of similar drainage-related interventions.
What You Will Learn
- The clinical context of endoscopic biliary drainage with a lumen-apposing metal stent
- The procedural steps involved in creating a choledochoduodenostomy
- How the case raises a root-operation classification question for inpatient coding
- The role of endoscopic ultrasound and fluoroscopy in the described intervention
Who Should Read This
- Medical coders
- Inpatient coding specialists
- Clinical documentation specialists
- Health information management professionals
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