AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2023 Issue 2; Ask the Editor

Direct Endoscopic Necrosectomy

A patient, who is status post cystoduodenostomy for acute necrotizing pancreatitis, compatible with walled-off pancreatic necrosis (WOPN), is admitted with abdominal pain and fever. During the upper endoscopic examination, a previously placed AXIOS™ cystoduodenostomy stent was found to be clogged by necrotic tissue. The cystic cavity was intubated with visualization of a significant amount of necrotic material within the cavity. A direct endoscopic necrosectomy (DEN) was performed and an EndoRotor® device was utilized to resect the necrotic tissue. The necrotic cavity was also irrigated to facilitate further liquefaction of the necrosis. What is the appropriate root operation for a direct endoscopic necroscectomy (DEN) when performed using an EndoRotor® device? Since the device can simultaneously aspirate and excise/resect necrotic tissue, it is unclear what root operation, Extraction, Excision, Extirpation, and/or Drainage best captures the intent of this procedure. ...

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