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Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions affecting the biliary and pancreatic ducts. This procedure is particularly significant when there is a need to remove foreign bodies or to change tubes or stents that have been previously placed in these ducts. During ERCP, a flexible endoscope is introduced through the esophagus, traversing the stomach, and reaching the duodenum, specifically targeting the area where the pancreatic duct and the common bile duct converge, known as the Ampulla of Vater. This anatomical landmark is crucial for accessing the ducts. Once the endoscope is in position, a smaller catheter is inserted through the endoscope to cannulate the Ampulla of Vater, allowing for the injection of contrast dye into the ducts. This contrast dye is essential for visualizing the biliary tract, gallbladder, and pancreas via x-ray imaging, which is performed immediately after the dye is injected. If a foreign body is present, the catheter is carefully advanced over a guidewire to the location of the obstruction or the previously placed tube or stent. To facilitate the removal of the foreign body or to replace the existing tube or stent, a basket extraction device is utilized, which captures the target object for extraction. This procedure not only aids in the removal of obstructions but also allows for the placement of new tubes or stents as necessary, ensuring the continued patency of the biliary and pancreatic ducts.
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The procedure of endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic retrograde removal of foreign body and/or change of tube or stent is indicated for several specific clinical scenarios. These indications include:
The procedure of ERCP with endoscopic retrograde removal of foreign body and/or change of tube or stent involves several critical steps, each designed to ensure effective diagnosis and treatment. The steps are as follows:
After the completion of the ERCP procedure, the patient is monitored in a recovery area to ensure stability and to manage any potential complications. It is common for patients to experience some discomfort or mild sedation effects, which typically resolve within a few hours. Follow-up care may include instructions regarding diet, activity level, and signs of complications such as fever or abdominal pain. The healthcare provider may also schedule follow-up appointments to assess the effectiveness of the procedure and the need for any additional interventions.
| Short Descr | ENDO CHOLANGIOPANCREATOGRAPH | Medium Descr | ERCP W/RTRGR RMVL FB&/CHNG TUBE/STENT | Long Descr | Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograde removal of foreign body and/or change of tube or stent | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special rules for multiple endoscopic procedures apply... | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Endoscopic Base Code | 43260 Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8B - Endoscopy - upper gastrointestinal | MUE | Not applicable/unspecified. | CCS Clinical Classification | 82 - Endoscopic retrograde cannulation of pancreas (ERCP) |
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