In interventional radiology coding, there are some complex non-vascular procedures. These procedures are mostly diagnostic procedures. Diagnostic procedures are done to find abnormalities related to particular organ. Abnormalities like obstruction, calculi or accumulation of fluid are common to find through diagnostic procedures. If we take medical coding as a career, learning these procedures will help in building your coding skills. So, here we will discuss one the diagnostic procedure named as percutaneous tranhepatic cholangiogram. From 2016, CPT code 47500, 47505, 47510, 47511, 47525, 47530 have been deleted, and new CPT codes 47531-47541 has been added for coding cholangiogram procedures.
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Procedure performed for CPT code 47531, 47532, 47533, 47534, 47536 & 47537
First the patient is anesthetized with a local anesthetic agent. Then under sterile condition a needle is inserted in the intrahepatic biliary duct. Since, the procedure is performed through hepatic biliary duct it is called as percutaneous transhepatic cholangiogram. When the needle is inserted, images were taken under fluoroscopic guidance. This will help in the checking the final position of the needle. Once, the needle reached at final point, a guide wire is placed along the needle. The needle is removed and a catheter is placed along the guidewire. Now, the contrast is injected through the catheter to perform cholangiogram.
When to use CPT code 47531, 47532, 47533, 47534, 47535, 47536 & 47537
The cpt codes are used depending on the documentation in the report. The cpt code for Percutaneous transhepatic cholangiogram is 47532 and is used when the cholangiogram is done through the newly placed catheter. 47531 cpt code is used when the cholangiogram is done through the already placed catheter. So, while coding any of these codes please check whether the catheter is new or already present. Also, there should be some diagnostic finding given after performing cholangiogram. Since, we are coding a diagnostic exam, diagnostic finding are must to code that cpt.
While placing T-Tube, always cholangiogram is performed to check the proper placement of T-tube. In some cases, it is very important to check why the cholangiogram is performed. There are two condition to perform cholangiogram
- To check the proper placement of T-tube.
- To find the diagnostic finding after placement of T-tube.
So, if the cholangiogram is performed just to check the final position of T-tube, the cholangiogram code is included with the T-tube placement cpt code . But, if there are diagnostic finding mention along with T-tube placement then cpt code should also be coded with 59 modifier.
Now, I hope you can have clear idea when to code the percutaneous transhepatic cholangiogram while placing T-tube. Also, how to use 59 modifier while coding these procedures.
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Description of CPT codes for Cholangiography procedures
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
47532 new access (eg, percutaneous transhepatic cholangiogram)
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
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 new access, without placement of separate biliary drainage catheter
47540 new access, with placement of separate biliary drainage catheter (eg, external or internal-external)
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
+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)
+47543 Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (eg, brush, forceps, and/or needle), including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, single or multiple (List separately in addition to code for primary procedure)
+47544 Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)
Supply and Equipment codes with for Cholangiography procedures
SA019 kit, iv starter
SA031 kit, suture removal
SA048 pack, minimum multi-specialty visit
SA067 tray, shave prep
SB001 cap, surgical
SB009 drape, sterile, femoral
SB019 drape-towel, sterile 18in x 26in
SB022 gloves, non-sterile
SB024 gloves, sterile
SB028 gown, surgical, sterile
SB033 mask, surgical
SB034 mask, surgical, with face shield
SB039 shoe covers, surgical
SB044 underpad 2ft x 3ft (Chux)
SC010 closed flush system, angiography
SC049 stop cock, 3-way
SC051 syringe 10-12ml
SC056 syringe 50-60ml
SC058 syringe w-needle, OSHA compliant (SafetyGlide)
SD089 guidewire, hydrophilic
SD090 guidewire, STIFF
SD136 vascular sheath
SD146 catheter percutaneous fastener (Percu-Stay)
SD147 catheter, (Glide)
SD149 catheter, balloon inflation device
SD150 catheter, balloon ureteral (Dowd)
SD163 drainage pouch, nephrostomy-biliary
SD171 guidewire bowl w-lid, sterile
SD312 Internal/external biliary catheter
SD313 Viabil covered biliary stent
SG009 applicator, sponge-tipped
SG055 gauze, sterile 4in x 4in
SG079 tape, surgical paper 1in (Micropore)
SH047 lidocaine 1%-2% inj (Xylocaine)
SH065 sodium chloride 0.9% flush syringe
SH069 sodium chloride 0.9% irrigation (500-1000ml uou)
SJ041 povidone soln (Betadine)
SM022 sanitizing cloth-wipe (surface, instruments, equipment)
ED050 Technologist PACS workstation
ED053 Professional PACS Workstation
EF018 stretcher
EF027 table, instrument, mobile
EL011 room, angiography
EQ011 ECG, 3-channel (with SpO2, NIBP, temp, resp)
EQ032 IV infusion pump
EQ168 light, exam