alligator biopsy-cytologic brushings biopsy??

[chembree]

How would you code the biopsies on this procedure?

PERCUTANEOUS BILIARY DRAIN CATHETER:

INDICATION: Intrahepatic ductal dilatation, hyperbilirubinemia,
suspected neoplastic stricture at confluence of left and right
intrahepatic ducts.

PROCEDURE/FINDINGS: After informed consent was obtained, under sterile
conditions and administration local anesthetic, a 21-gauge needle was
used to puncture the right dilated biliary radical. An .018 guidewire
was inserted. The .018 guidewire did traverse the tight stenosis related
to stricture. Next, a transitional catheter set was used. An .035
guidewire was utilized. An 8-French sheath was placed through which
cytologic brushings were made across a stricture in addition to an
alligator biopsy device being used to obtain tissue, placed in formalin.
Over a guidewire, an 8-French pigtail internal/external biliary drain
was placed and connected to gravity drainage bag and secured to the
patient's skin.

The patient was provided Versed and fentanyl given intravenously for
adequate conscious sedation during the procedure.

IMPRESSION:

1. Internal/external biliary drain placement following biliary stricture
cytologic brushings and forceps biopsy of stricture.

2. The patient may need a left-sided drain for further decompression if
bilirubin does not improve significantly with this internal/external
drain.

[Jim Pawloski]

Originally Posted by c422rad

How would you code the biopsies on this procedure?

PERCUTANEOUS BILIARY DRAIN CATHETER:

INDICATION: Intrahepatic ductal dilatation, hyperbilirubinemia,
suspected neoplastic stricture at confluence of left and right
intrahepatic ducts.

PROCEDURE/FINDINGS: After informed consent was obtained, under sterile
conditions and administration local anesthetic, a 21-gauge needle was
used to puncture the right dilated biliary radical. An .018 guidewire
was inserted. The .018 guidewire did traverse the tight stenosis related
to stricture. Next, a transitional catheter set was used. An .035
guidewire was utilized. An 8-French sheath was placed through which
cytologic brushings were made across a stricture in addition to an
alligator biopsy device being used to obtain tissue, placed in formalin.
Over a guidewire, an 8-French pigtail internal/external biliary drain
was placed and connected to gravity drainage bag and secured to the
patient's skin.

The patient was provided Versed and fentanyl given intravenously for
adequate conscious sedation during the procedure.

IMPRESSION:

1. Internal/external biliary drain placement following biliary stricture
cytologic brushings and forceps biopsy of stricture.

2. The patient may need a left-sided drain for further decompression if
bilirubin does not improve significantly with this internal/external
drain.

Use 47552 - Choleangioscopy, perc., w/ or w/o brushing or washing
and 47553 - Choleangioscopy, perc. with biopsy

[elamathi]

My codes are,

47511
47552
75982
99144

You may need to clarifiy whether to code an Unlisted procedure for aligator biopsy of the stricture.

Elamathi

[chembree]

I seen the 47552 and 47553 but did not think I could use them because they includes endoscopy?

[Jim Pawloski]

Originally Posted by c422rad

I seen the 47552 and 47553 but did not think I could use them because they includes endoscopy?

According to SIR, Cpt editorial panel and CMS states that "endoscopy codes" are considered accurate for discribing codes 47552 - 47556, done either endoscopically or percutaneously.

[chembree]

That is very helpful! Can you send me the link to this information so that I can show this to the other coders in the office!


Thanks so much!
Christy Hembree,CPC

[Jim Pawloski]

Originally Posted by c422rad

That is very helpful! Can you send me the link to this information so that I can show this to the other coders in the office!


Thanks so much!
Christy Hembree,CPC

I found the info in the Society of Interventional Radiology's Coding Users' Guide on Pgs. 126-7 on the use of "scopy" codes.