AHA Coding Clinic® for HCPCS - 2021 Issue 4; Ask the Editor

ERCP with hot snare polypectomy

A patient presents for evaluation of a bile duct mass. He is post laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) with stent placement. A bile duct adenoma was noted that was not amenable to endoscopic resection. The endoscope was introduced through the mouth and advanced under direct visualization until bifurcation of the main biliary duct was reached. The biliary bile duct was deeply cannulated with a balloon and a wire. Abrupt shelf-like narrowing was identified in the periampullary bile duct consistent with the endoscopic ultrasound (EUS) findings of a mass in this region. Upstream bile duct was diffusely dilated about 14 mm. Visualized intrahepatic bile ducts appeared normal. Bile duct was swept from the bifurcation. Polypoid tissue was extruded from the distal bile duct during balloon sweeps. Subsequently a hot snare was used to resect polypoid tissue for histology. A 10 mm x 6 cm fully covered metal stent was deployed extending across this area from the bile duct into the duodenum. Since there is no CPT code that describes an ERCP with hot snare polypectomy, what is the appropriate code for this procedure? ...

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