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Code This!

Scenario Week of August 30, 2012:
View Current Scenario

Assign the appropriate ICD-9-CM diagnosis and procedure codes as well as CPT for the following outpatient scenario:

Operative report: Endoscopic ultrasound
Needle aspiration of pancreatic cyst

Diagnosis: Pancreatic cyst, compatible with pseudocyst, rule out mucinous cystic neoplasm
Changes suggestive of chronic pancreatitis if the cyst is a pseudocyst or for chronic pancreatitis if it is not a pseudocyst

Description of procedure: After sedation was administered, the linear EUS scope was advanced to the area of the duodenum. A detailed examination of the pancreas and surrounding structures was obtained.

Findings: The pancreatic duct body appeared dilated at 2.9 mm and the duct walls were hyperechoic. The pancreatic parenchyma had hyperechoic nonshadowing foci, and there was a cystic lesion adjacent to the stomach. It was approximately 4 cm x 4 cm. It was anechoic and thick walled. There were no internal septa noted. There was acoustic enhancement noted. The visualized biliary tree appeared normal. There was shotty periportal and peripancreatic adenopathy with heterogeneous irregularly shaped lymph nodes that did not meet the criteria for malignancy. There were no masses seen. The cyst was aspirated with 1 pass with a 22-gauge Wilson-Cook coil US needle. Approximately 20 mL of clear fluid were aspirated and the cyst was completely collapsed. Levaquin 750 mg IV was given once. The cyst fluid was sent for amylase, CEA, mucin, and cytology. The note was made that there was protuberance in the stomach on endoscopic view before the cyst was aspirated, which was gone afterwards. Also, note should be made that there was no clear-cut communication via EUS of the pancreatic duct and the cystic area.

Code This! Assign the correct CPT and ICD-9-CM diagnosis and procedure codes.

CPT Code
43240 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transmural drainage of pseudocyst

ICD-9-CM Diagnosis Code
577.2 Cyst and pseudocyst of pancreas

ICD-9-CM Procedure Codes
52.01 Drainage of pancreatic cyst by catheter
88.74 Diagnostic ultrasound of digestive system

The diagnosis confirmed at the end of the procedure was pancreatic cyst 577.2. This code also represents pancreatic pseudocyst. A condition stated as “rule out” or “suggestive of” such as the mucinous cystic neoplasm or chronic pancreatitis, cannot be assigned on this outpatient encounter because these phrases indicate uncertainty. The surgical approach, endoscopy, is not assigned in ICD-9-CM, therefore, only 52.01 is assigned for the needle aspiration. CPT code 43240 includes echoscopy, when performed, according to CPT Assistant Oct. 2011 pg 4-7.

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