THE CODING EDGE® ARCHIVES

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Procedure Practice 07/15/98 - Feature Article 07/15/98
   

Procedure Practice 07/15/98:
Coding Recommendations

  
Listed below are the ICD-9-CM diagnosis and procedure codes as well as the CPT-4 procedure codes that we think properly classify this episode of treatment. Please note that modifiers, used only for physician billing purposes, have not been assigned to the CPT-4 codes. If you disagree with our suggestions or have other comments, please send an e-mail to codingedge@lagunamedsys.com.
   

Suggested Codes and Rationale

  
Diagnoses

The patient has an obstructing common duct calculus without other documented biliary disease. In the Disease Index, the entry under "calculus, common duct" refers the coder to "choledocholithiasis." Choledocholithiasis directs the coder to 574.5 in the Tabular List. This code requires a 5th digit to indicate obstructing vs. nonobstructing stone. Because the stone was obstructing the papilla of Vater, the correct code is 574.51, Calculus of bile duct without mention of cholecystitis, with obstruction.

Additional diagnoses for this patient are coded as follows:

Duodenal diverticulum. In the Disease Index, the entry "diverticula, intestine, small" directs the coder to 562.00. The entry 562.00 in the Tabular List confirms that this is the correct code, Diverticulosis of small intestine (without mention of hemorrhage).

Right hepatic duct stricture. In the Disease Index, we find the code 576.2 next to the entry for "Stricture, hepatic duct." The Tabular List confirms that 576.2, Obstruction of bile duct, except cystic duct, without mention of calculus, is the correct code.
   

ICD-9-CM Procedures

In the Procedure Index under "ERCP" we find the code 51.10. Category 51.1, "diagnostic procedures on biliary tract," in the Tabular List contains an excludes note. The note indicates that this code should not be used if a surgical procedure was performed via ERCP. Since a sphincterotomy and common duct stone removal were performed, the 51.1 category is not appropriate. Going back to the Procedure Index, "sphincterotomy, sphincter of Oddi, endoscopic" directs the coder to 51.85. The Tabular List confirms that this is the correct code to identify the sphincterotomy portion of the procedure: Edoscopic sphincterotomy and papillotomy...by procedures classifiable to 51.10-51.11, 52.13.

The procedure described also includes endoscopic removal of a common bile duct stone. In the Procedure Index,we find the code 51.88 under the terms "removal, gallstones, common duct, endoscopic." The description in the Tabular List verifies that this is the correct code, Endoscopic removal of stone(s) from biliary tract...by procedures classifiable to 51.10-51.11, 52.13.
  

CPT-4 Procedures

In the Index, "cholangiopancreatography with surgery" lists a series of codes in the 43262-43269 range. A review of the code descriptions in this range shows that two codes are required to describe the procedures performed: 43262, ERCP with sphincterotomy/papillotomy; and 43264, ERCP with endoscopic retrograde removal of stone(s) from biliary and/or pancreatic ducts.

Procedure Practice 07/15/98 - Feature Article 07/15/98
Bibliography - References:
Coder’s Desk Reference, Medicode Publishing, Salt Lake City, UT.
Code It Right, Medicode Publishing, Salt Lake City, UT
Coding Clinic, 2nd Qtr. 1989; 4th Qtr. 1990; November-December 1987; 2nd Qtr. 1997. American Hospital Association, Chicago, IL
CPT 98 Physicians’ Current Procedural Terminology, American Medical Association, Chicago, IL.
St. Anthony's HCPCS Report, Dec. 1992, St. Anthony Publishing, Inc., Reston, VA.
St. Anthony’s Illustrated ICD-9-CM Code Book, St. Anthony’s Publishing, Reston, VA.		 Notice: This part of our web site was prepared to assist in understanding and maintaining good coding skills. For proper use of this feature, reference must be made to official coding guidelines when necessary. The information here presented is only to be used as a supplement to those guidelines. Laguna Medical Systems, Inc., makes no representations or guarantees as to amounts that will be paid by Medicare or other third party payers.

 

Please be aware that the Coding Edge® Archive pages are NOT retroactively updated
to reflect possible coding rules and regulation changes made after the publishing date.