Health Information Management

Ask the expert: Coding cholangiocarcinoma with obstructed biliary stents

HIM-HIPAA Insider, August 28, 2007

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Q: A physician documented the following secondary diagnosis on an inpatient: Cholangiocarcinoma with obstructed biliary stents.

I know I would report code 155.1 for the cholangiocarcinoma, but I am unsure about the obstruction code. Should I report code 576.2 (Obstruction of bile duct;Occlusion, Stenosis, Stricture of bile duct, exceptcystic duct, without mention of calculus)? That code really doesn't describe the condition, which is obstruction of the stents. 

A: Code the obstructed biliary stent as 996.79 and, yes, you would also assign 576.2 for the obstruction of the bile duct. Coding Clinic, first quarter, 2001, pp. 8-9, states the following:

Question: A patient with chronic pancreatitis with biliary stricture and pancreatic duct stones who is status post ESWL was admitted for ERCP. During the procedure, a partially occluded biliary stent was removed with a polyp snare. What codes are appropriate for this surgery?

Answer: Assign code 996.79, Other complications of internal (biological) synthetic prosthetic device, implant, and graft, Due to other internal prosthetic device implant, and graft, for the occluded biliary stent, as the principal diagnosis. Code 577.1, Chronic pancreatitis, code 576.2, Obstruction of bile duct, for the biliary stricture, and code577.8, Other specified disorders of pancreas, should be assigned as secondary diagnoses. Assign code 97.55,Removal of T-tube other bile tube, or liver tube, for the endoscopic removal of the occluded biliary stent. The index to procedures (Volume 3) and the excludes note direct the coder to 97.55 for nonoperative (endoscopic) removal of a biliary tube. Assign also code 51.10, Endoscopic retrograde cholangiography [ERCP], for the ERCP.

Editor's note: This question and answer appeared in the August 2007 issue of Briefings on Coding Compliance Strategies. For more information, click here.

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