Superb tips for New Cpt codes for Percutaneous transhepatic and tube Cholangiogram

Percutaneous transhepatic and tube Cholangiogram
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The patient is placed supine on the procedure table and prepped and draped sterilely. The physician injects dye into the bile ducts via a catheter that is already in place in the bile duct. Likewise, the T-tube is most commonly inserted during a cholecystectomy operation which is used to check the possibility of residual gall stones within the biliary duct. A separate radiological study of the ducts is then performed. These tips are really important for Certification exams like CPC, you can go through sample CPC questions here which will surely help in clearing CPC exam.




Deleted and New CPT codes in 2016

 In 2016, we have new CPT codes for coding Cholangiogram. Few old CPT codes will be get deleted and the new CPT codes will replace them. The new CPT codes will be bundled procedures and hence we will have only one CPT code for coding cholangiogram procedures. The New codes include all the radiological supervision and interpretation procedures which we used to code separately earlier. Below are the list of Deleted and New CPT codes in 2016.

Deleted Codes
Description
74305
Cholangiography and/or pancreatography; through existing catheter, radiological supervision and interpretation
74320
Cholangiography, percutaneous, transhepatic, radiological supervision and interpretation
74327
Postoperative biliary duct calculus removal, Percutaneous, via T-tube tract, basket or snare
75980
Percutaneous transhepatic biliary drainage with contrast monitoring, radiological supervision and interpretation
75982
Percutaneous placement of biliary drainage catheter for combined internal and external biliary drainage or of a drainage stent for internal biliary drainage in patients with an inoperable mechanical Biliary obstruction, radiological supervision and interpretation



















Deleted Codes
Description
47500
Injection procedure for percutaneous transhepatic cholagiography
47505
Injection procedure for cholangiography through an existing catheter (eg, percutaneous Transhepatic or T-tube)
47510
Introduction of percutaneous tanshepatic catheter for biliary drainage
47511
Introduction of percutaneous tanshepatic stent for internal and external biliary drainage
47525
Change of percutaneous biliary drainage catheter
47530
Revision and/or reinsertion of Transhepatic tube





New Codes
Description
47531
Injection procedure for cholangiogram, 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 cholangiogram 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 cholangiogram when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation
47536
Exchange of Biliary drainage catheter (eg, external, internal-external, or conversion of external to internal only) Percutaneous, including diagnostic cholangiogram 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 internal Biliary stents), including diagnostic cholangiogram 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, ultrasound and/or fluoroscopy), 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 a Biliary tree and into small bowel to assist with an endoscopic Biliary procedure (eg, rendezvous procedure), Percutaneous, including diagnostic cholangiogram 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 diagnostic cholangiogram when performed, imaging guidance (eg, ultrasound and/or 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, electrohydrolic, lithotripsy) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)


 

Terminology
Cholangiography is a radiological examination of bile duct using contract.  Postoperative cholangiography is done through an existing catheter and is used to detect retained common bile duct stones after the gallbladder has been removed, and to demonstrate good flow of bile contrast into the duodenum. Radiopaque dye is injected through a T-tube, which is a device inserted into the biliary duct and brought out through the abdominal wall after bile duct exploration and removal of the gallbladder. It allows for drainage of the bile duct and for introduction of contrast medium for postoperative radiological study of the bile duct. 74305 code reports only the radiological supervision and interpretation. The injection of the dye through the T-tube is reported separately. This code is used along with 47505 which is used for the injection procedure for cholangiography through an existing catheter (eg, percutaneous transhepatic or T-tube). the



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Tips

Question: How should I code a report for injection of contrast material through a surgically placed T-tube to view bile ducts along with separate radiological supervision and interpretation (RS&I) during a pancreatography?

Answer: If the radiologist performs the T-tube study after (not during) the surgery, which is most often the case for radiology services, report 74305 (Cholangiography and/or pancreatography; through existing catheter, radiological supervision and interpretation) for the RS&I and 47505 (Injection procedure for cholangiography through an existing catheter [e.g., percutaneous transhepatic or T-tube]) for the injection, because the radiologist performs the contrast injection through a previously placed catheter.

If the surgeon performs the intraoperative contrast injection and you are coding only for the imaging service, you would report 74300 (... intraoperative, radiological supervision and interpretation).

If you are coding for the radiologist's professional service, and the radiologist is not present during the intraoperative contrast exam, add modifier 52 (Reduced services) to show that you are billing for interpretation only. If the surgeon supervised the imaging but did not interpret the films, the surgeon's claim should also include modifier 52.

You may report +74301 (… additional set intraoperative, radiological supervision and interpretation [list separately in addition to code for primary procedure]) as an add-on to 74300, representing the separate S&I for subsequent sets of images obtained during the surgery. There are no injection codes for these intra-operative images because the injection of contrast by the surgeon is bundled into the surgery


PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAM WITH PLACEMENT OF AN INTERNAL/EXTERNAL CATHETER

INDICATION: Patient with biliary obstruction. The patient has undergone an ERCP without success. Antegrade access is requested.Ovarian cancer

TECHNIQUE: The procedure, risks, indications, and alternatives had all been explained to the patient's family by the gastroenterologist.

All questions were answered. Consent had been obtained and signed.

The abdomen was prepped and draped in the usual sterile fashion. A 22-gauge 15 cm Chiba needle was advanced into the liver and on the first pass a bile duct was accessed. A cholangiogram was performed.

A peripherally located posterior right-sided duct was then accessed with an AccuStick needle in a peripheral location. A guidewire was advanced centrally. A Berenstein catheter and Glidewire were advanced to the common hepatic duct which was completely occluded at its junction with the common bile duct. Catheter and Glidewire were then able to be manipulated through the occlusion and through the ampulla into the duodenum.
Endoscopic visualization of the guidewire was obtained. The guidewire was snared. Through and through access was obtained. A retrograde 10 French stent was then placed by the gastroenterologist.
The biliary system was decompressed. The tract was embolized with Gelfoam torpedoes. No extravasation from the bile duct was seen post embolization.
FLUOROSCOPY TIME: 8.5 minutes of fluoroscopy time.
CONTRAST: 10 mL isovue 250
ESTIMATED BLOOD LOSS: Less than 10 mL.
POST OPERATIVE DIAGNOSIS: Same.
FINDINGS: There is complete obstruction of the common hepatic duct/common bile duct junction and along the majority of the length of the common bile duct. There is intrahepatic biliary ductal
dilatation.
The posteriorly oriented right-sided duct was accessed.
Following embolization, no contrast is seen coursing out along the
tract. Some contrast during the injection is seen in the perihepatic
space.
IMPRESSION:
1. Successful right-sided percutaneous transhepatic cholangiogram
with access into a right sided posterior duct and placement of a 4
French internal/external catheter which ultimately served as a guide
for retrograde placement of a 10 French endoscopic stent.
CPT: 47500, 74320-26

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