When to use 47531 and 47532

A radiographic medium is injected into the common bile duct, gallbladder, and/or liver for diagnostic purposes. The physician inserts a needle between the ribs into the lumen of the common bile duct and checks positioning by aspiration. Radiographic dye is injected. The needle is removed. This procedure includes imaging guidance and all radiological supervision and interpretation. CPT code 47531 is reported when the service is performed through an existing access, such as a T-tube. CPT code 47532 is reported when the service is performed via a new access.

47531 – Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; existing access

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When to use 47533, 47534, 47535, 47536 and 47537

For CPT code 47533, the physician introduces a catheter into the liver to drain fluid using ultrasound and/or fluoroscopy to guide the process. The puncture site on the right side of the body is incised, the needle inserted between the ribs, advanced into the liver, and into the bile duct. Contrast medium is injected to visualize the intrahepatic bile ducts. A guidewire is inserted and advanced to the point of obstruction through an optimal duct permitting access and drainage. A catheter is threaded over the guidewire and dilators may be used to enlarge the opening and the tract from the skin to the bile duct. The drainage catheter is inserted and positioned above the point of the obstruction and secured to the skin. All of the bile drains out of the body through the catheter and into a collection bag. Occasionally, the use of two separate catheters is necessary to drain the right and left biliary duct systems.

For CPT code 47534, the physician introduces a catheter into the liver to drain fluid internally and externally, usually on patients with inoperable bile duct obstruction. The procedure is the same as in the external procedure except that a drainage catheter is inserted and positioned so that openings for drainage are above and below the obstruction and secured in place. This allows bile to flow to an external drainage system as well as into the duodenum (internal). CPT code 47535 is reported for a percutaneous conversion from an external biliary drainage catheter to internal-external. CPT code 47536 is reported for a percutaneous exchange, such as external, internal-external, or conversion of internal-external to external only. CPT code 47537 is reported for the removal of a biliary drainage catheter. Codes 47533-47537 include diagnostic cholangiography (when performed), imaging guidance (fluoroscopy), as well as all associated radiological supervision and interpretation.

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 

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 

47536 Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation 
 

47537 Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (eg, with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation 

When to use 47538, 47539 and 47540

The physician inserts a thin needle through the skin and into the liver and injects contrast material for x-rays in order to diagnose and treat obstructions impacting the flow of bile from the liver to the gastrointestinal (GI) tract. Once the stricture or obstruction is identified, the physician places an introducer sheath into the biliary system. Under ultrasonic or fluoroscopic guidance, a stent delivery system is placed within a narrow section of the bile duct in order to keep the duct patent. Stents may be comprised of metallic mesh or plastic tubing.

A balloon-tipped catheter may be required to achieve adequate expansion of the narrow duct. The stent may be a self-expandable stent, which means it opens by itself once deployed, or balloon expandable, meaning a balloon is required in order to open the stent. When a balloon expandable stent is used, the stent is generally placed over a balloon tipped catheter because once the balloon is expanded the catheter pushes the stent into place against the duct wall.

Once the balloon tipped catheter is deflated and removed, the stent stays in place and functions similarly to a scaffold for the duct. A hilar malignancy may create an obstruction within both hepatic ducts and require the use of a bilateral stent. CPT code 47538 is reported when this procedure is performed via an existing access site; CPT code 47539 is reported when performed via a new access site without placement of separate biliary drainage catheters; and CPT code 47540 is reported when performed via a new access site with placement of separate biliary drainage catheters (external or internal-external). The use of imaging, diagnostic cholangiography, balloon dilation, and/or the exchange or removal of catheters, as well as all supervision and interpretation, is included in these procedures, when performed.

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, each stent; existing access

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

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

When to use CPT code 47541

For CPT code 47541, placement of access through the biliary tree and into the small bowel is performed to assist in an endoscopic biliary procedure, such as rendezvous. The physician inserts a needle through the skin and liver moving it into the bile duct for a biliary drainage procedure. For stent placement, a drainage tube is typically placed prior to stent insertion. If this fails to resolve the obstruction, the physician inserts a guidewire and the tube is removed. A sheath is placed over the guidewire and a stent delivery system is placed within the narrow section. Tissue samples and stone removal may be performed via this access. This code includes all imaging guidance. Report this code if the access is new.

47541 – Placement of access through the biliary tree and into small bowel to assist with an endoscopic biliary procedure (eg, rendezvous procedure), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation, new access

When to use CPT code 47542

For CPT code 47542, Percutaneous balloon dilation of a biliary duct or repair of the ampulla is most often required to widen a stricture or remove stones. The repair is done due to damage caused by the stricture, stone, or by the dilation itself. The provider inserts a needle through the skin and into the biliary duct and the needle is advanced through the stricture, allowing for insertion of a balloon catheter. A guidewire is inserted over the needle into the biliary duct and the needle is removed. The balloon is placed over the guidewire. Under imaging guidance, the balloon is filled with saline in order to stretch the vessel. The size of inflation and continuity depend on the patient’s diagnosis and dispensation. Once the procedure is complete, the instruments are removed and simple closure of the access site is performed.

+47542 – Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each duct (List separately in addition to code for primary procedure)

It is important to emphasize that codes 47533-47540 include the elements of access, drainage catheter manipulations, diagnostic cholangiography, imaging guidance (eg, ultrasonography and/or fluoroscopy), and all associated radiological supervision and interpretation.

CPT code 47541 describes the work involved in obtaining a new percutaneous access through the biliary tree and into the small bowel to assist with an endoscopic biliary procedure. Often, these procedures, which are commonly called rendezvous procedures, are performed in conjunction with other procedures (eg, ERCP procedures) that are performed by other providers. Devices placed for the rendezvous procedure may include a guide wire and/or a catheter. However, code 47541 may not be reported if a guide wire is placed through an existing percutaneous biliary access.

Codes 47542, 47543, and 47544 describe procedures that may be performed in conjunction with other procedures in the percutaneous biliary code family (47490, 47531-47540). Codes 47542, 47543, and 47544 do not include access, catheter placement, or diagnostic imaging. Code 47542 describes the work of balloon dilation of biliary ducts or the ampulla; while code 47543 describes the work of endoluminal biopsy of the biliary tree. Code 47544 describes the work of removal of calculi/debris from the biliary ducts and/or gallbladder.

CPT Code 47542 should not be reported with codes 47538-47540, as the work of balloon dilation is included in biliary stent placement. If a balloon dilation is performed only to remove calculi/debris, code 47542 should not be reported; instead, report code 47544.Note that code 47543 may be reported only once per procedure, regardless of how many biopsy specimens are obtained and regardless of the means by which they are obtained. Code 47544 may not be reported if no debris/calculi is present, regardless of whether the removal device is deployed. In addition, it should not be reported for incidental removal of debris, such as during injection of contrast material for cholangiography.

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Do and Don’t of CPT code 47531, 47537, 43738, 43739, 43740, 43741 & + 43742

Use 47542 in conjunction with 47531, 47532, 47533, 47534, 47535, 47536, 47537, 47541.

Use 47543 & 47544 in conjunction with 47531, 47532, 47533, 47534, 47535, 47536, 47537, 47538, 47539, 47540

Code 47542 once when multiple balloon dilations are performed via a single access.

Do code biliary tube removal CPT code 47537 with cholangioplasty, but do not code with stent placement procedures.

Do not report 47537 in conjunction with 47538 for the same access

Do not report 47536 in conjunction with 47538 for the same access

Codes 47538, 47539, and 47540 include all diagnostic cholangiography and hence do not report CPT code 47531 or 47532 along with these CPT codes. Also the imaging guidance like fluoroscopy, ultrasound, CT, MRI are included in these procedures codes, hence do not code them separately.