AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2025 Issue 3; Ask the Editor
Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) Procedure Status Post Gastric Bypass
A patient with history of a Roux-en-Y-gastric bypass was admitted with choledocholithiasis. During the admission, the patient had an endoscopic ultrasound (EUS) directed trans-gastric ERCP (EDGE) procedure with stent placement for a biliary anastomotic stricture. This is a two-stage procedure where in stage one, a fistula is created to connect the gastric pouch to the excluded stomach. Once the fistula forms, stage two is completed which involves relieving any obstructions, diagnosing tumors, and removing gallstones from the bile ducts and/or pancreas, when necessary. During the first stage of the procedure, the “excluded” stomach was accessed utilizing a needle. A wire was advanced, and a lumen-apposing metal stent (LAMS) was placed between the excluded stomach and gastric pouch. The LAMS was then dilated. What is the appropriate ICD-10-PCS codes for stage 1 of the EDGE procedure? ...
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Article Overview
This article reviews a staged EDGE procedure in the setting of prior Roux-en-Y gastric bypass and biliary disease, with emphasis on the procedure context, staging, and the ICD-10-PCS coding question for the initial stage. It is intended for coders, CDI staff, and revenue cycle professionals who need to understand how the procedure is described and what coding topic the article addresses. The discussion stays focused on the clinical scenario, procedural staging, and the coding framework involved without disclosing the premium article’s full coding determination.
Why This Topic Matters
Staged procedures after gastric bypass can be difficult to interpret for accurate inpatient procedure coding. Understanding the anatomy and the procedural sequence helps coders evaluate the case within ICD-10-PCS guidance and related documentation.
What You Will Learn
- How the EDGE procedure is staged in a post-gastric bypass setting.
- What procedural elements are described in the initial stage of the case.
- Why the scenario raises an ICD-10-PCS coding question.
- How the article frames the coding challenge for stage one.
Who Should Read This
- Inpatient coders
- CDI specialists
- Revenue cycle professionals
- Health information management staff
- Coding educators
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