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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