How To Use HCPCS Code C7544

HCPCS code C7544 describes a specific medical procedure known as endoscopic retrograde cholangiopancreatography (ERCP) with the removal of calculi/debris from the biliary/pancreatic duct(s), along with endoscopic cannulation of the papilla and direct visualization of the pancreatic/common bile ducts. This code is used to identify and bill for this particular procedure, which involves the use of an endoscope to diagnose and treat conditions affecting the bile ducts and pancreas.

1. What is HCPCS C7544?

HCPCS code C7544 is a specific code used in medical coding to identify the procedure of endoscopic retrograde cholangiopancreatography (ERCP) with the removal of calculi/debris from the biliary/pancreatic duct(s), along with endoscopic cannulation of the papilla and direct visualization of the pancreatic/common bile ducts. This code is essential for accurate billing and reimbursement purposes.

2. Official Description

The official description of HCPCS code C7544 is “Endoscopic retrograde cholangiopancreatography (ERCP) with removal of calculi/debris from biliary/pancreatic duct(s), with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s).” The short description for this code is “Parenteral supp not othrws c.”

3. Procedure

1. The procedure begins with the insertion of an endoscope through the mouth and into the esophagus.
2. The endoscope is then guided through the stomach and into the duodenum.
3. Once the endoscope reaches the papilla, a small opening is made to access the bile ducts and pancreatic duct.
4. A contrast dye is injected into the ducts to enhance visibility during the procedure.
5. Using specialized tools, the healthcare provider removes any calculi or debris present in the biliary or pancreatic ducts.
6. Throughout the procedure, direct visualization of the ducts is maintained to ensure accurate removal of calculi/debris.
7. Once the procedure is complete, the endoscope is carefully removed.

4. When to use HCPCS code C7544

HCPCS code C7544 should be used when performing endoscopic retrograde cholangiopancreatography (ERCP) with the specific purpose of removing calculi/debris from the biliary/pancreatic duct(s). This code is applicable when the healthcare provider performs the procedure and meets the necessary criteria outlined in the official description.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C7544, healthcare providers must ensure that the documentation accurately reflects the performance of the procedure. It is essential to include details such as the specific ducts involved, the presence of calculi/debris, and the use of direct visualization during the procedure. Additionally, any necessary supporting documentation, such as images or reports, should be included to substantiate the billed service.

6. Historical Information and Code Maintenance

HCPCS code C7544 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. As indicated by the action code N, no maintenance actions have been taken for this code. This means that there have been no updates or revisions since its addition to the coding system.

7. Medicare and Insurance Coverage

HCPCS code C7544 is eligible for coverage under Medicare. The pricing indicator code 57 indicates that this code is priced by other carriers. The multiple pricing indicator code A signifies that it is not applicable as HCPCS is priced under one methodology. Healthcare providers should consult the Medicare Carriers Manual Reference Section Number 2130 for specific guidelines and instructions regarding reimbursement for this procedure.

8. Examples

Here are five examples of scenarios in which HCPCS code C7544 should be billed:

1. A patient presents with symptoms of biliary colic and undergoes an ERCP procedure to remove gallstones from the common bile duct.
2. A patient with chronic pancreatitis requires an ERCP procedure to clear debris from the pancreatic duct and alleviate symptoms.
3. An individual with a history of choledocholithiasis undergoes an ERCP with stone extraction to prevent further complications.
4. A patient with obstructive jaundice undergoes an ERCP to remove a common bile duct stone causing the obstruction.
5. A post-operative patient develops a bile leak and requires an ERCP to identify and treat the source of the leak.