Coding guide for Biliary drainage catheter & Stent placement

Basics about CPT code 47533, 47534

Before going ahead about biliary drainage catheter, we have to understand about difference between external and internal biliary drainage catheter. If you are not aware of biliary procedure, you can refer the cholangiogram procedure first.

In Eternal biliary drainage catheter, one end of the catheter is in a bile duct and other is outside the patient’s body. It is a catheter placed into a bile duct that does not terminate in the bowel, which drains bile externally only.

In Internal-external biliary drainage catheter, one end of the catheter is in the duodenum and the other is outside the body, so bile can drain either internally into bowel or externally into a collection bag.

Along with drainage catheters, we have separate CPT code for biliary stents as well.

Biliary stents are percutaneously placed devices (eg, self-expanding metallic mesh stent, plastic tube) that are positioned within the biliary tree and completely internal, with no portion extending outside the patient.

Table of Contents

Procedure included in 47533, 47534 CPT code

CPT code 47533 is reported for Placement of an external biliary drainage catheter and CPT code 47534 for placement of an internal-external drainage catheter.

47533 Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; external

47534 internal-external

CPT code 47533 and 47534 includes:

Access
Catheter manipulation
Diagnostic cholangiography if performed
All imaging guidance
Radiological S&I (Supervision and Interpretation)

Since the above procedure codes 47533 & 47534 includes the cholangiography, you will not have to use CPT code 47531 and 47532 along with them.

Coding tip for use of Multiple drainage catheter

Sometimes the physician insert more than one drainage catheter. For example, the physician places separate catheters in the left and right biliary ductal systems if there are obstructions on both sides of the liver.

As per CPT coding guidelines, cpt code 47533 & 47534 can be reported only once for each drainage catheter. Under MUEs (Medical Medically Unlikely Edits ) code 47533 has a limit of 1 unit per day and 47534 has a limit of 2 units per day.

When to use CPT code 47538, 47539 & 47540

There are 3 codes for placement of biliary stents. Each procedure code includes all the minor procedures used to perform these exams.

When the stent is inserted through an existed access, the stent placement is reported with code 47538. his code includes the placement of a new external or internal-external drainage catheter through the same access following the stent placement.

Stent placement through new access is reported by two codes depending on whether the physician also places an external or internal-external drainage catheter during the same encounter

Report code 47539 if the physician does not place a drainage catheter, or code 47540 if the physician does place a drainage catheter.

47538 – Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation; existing access

47539 ; new access, without placement of separate biliary drainage catheter

47540 ; new access, with placement of separate biliary drainage catheter (eg, external or internal-external)

The use of imaging, diagnostic cholangiography, balloon dilation and/or the exchange of removal of catheters, as well as the supervision and interpretation, is included in these procedures, when performed.

Use of External to inernal-external CPT code 47535

Patients with biliary obstruction are often converted from one form of drainage to another. For example, a patient first receives an external drainage catheter and the later the physician replaces it with an internal external catheter that can be capped for a trail of internal drainage.

Conversion of an external drainage catheter to an internal-external drainage catheter is reported with code 47535

47535 : Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation

This code includes the removal of old catheter, diagnostic cholangiograms if performed, radiologic S&I and placement of the new catheter. By CPT coding guidelines you can report 2 unites of code 47535 if 2 catheters are converted but Medicare allows only 1 unit per date of service.

References:

http://library.ahima.org/doc?oid=84875#.W_1uNugza00

https://www.aapc.com/blog/34381-cpt-2016

http://bioportal.bioontology.org/ontologies/