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#1
09-03-2009, 11:02 AM
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Catheter Change and Duct Brushing
Can someone please give me some CPT assitance. I believe I should code this report with 47525, 75984,47999, and 99144 but I am not sure.
The patient was placed on table in supine position. Monitored conscious sedation was administered for 30 minutes. The indwelling right internal/external biliary drainage catheter and surrounding skin were prepped and draped in sterile fashion. Local anesthesia was infused at the entry site. Small amount of contrast was introduced via the catheter to opacify the biliary system. The indwelling 8 French internal/external biliary drainage catheter was exchanged out over an Amplatz guidewire. A 6 French Balkan sheath was then advanced across the occluded segment of the distal common bile duct at the enteric anastomosis. Cytology brush was advanced to the Balkan sheath and positioned across the occluded segment and brushings obtained. To cytology brushes were utilized in series. Both were processed inside light for cytopathology. Next, the Balkan sheath was exchanged out over the Amplatz wire for a new 8 French internal/external biliary drain. The distal loop was formed within the jejunum in the proximal side holes positioned along the common hepatic duct and extending into the central aspect of the right intrahepatic bile duct. Catheter was flushed and returned to external gravity drainage. The catheter was secured at the skin with suture of 2-0 Ethilon an sterile dressing applied. Patient tolerated the procedure well. No complication was encountered. 
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#2
09-03-2009, 11:17 AM
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http://www.aapc.com/memberarea/forum...ad.php?t=20197
As far as coding the cytologic brushings I posted a similar question to this a while back and was told… 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. (Society of Interventional Radiology's Coding Users' Guide on Pgs. 126-7 on the use of "scopy")
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#3
09-03-2009, 11:23 AM
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Per the Interventional Radiology Coding Users' Guide for 2009 codes 47552-47556 are to be considered the accurate codes for describing these services whether performed percutaneously or by endoscopic approach.
I'm thinking 47552 for this one...along with 75984/47525 Biliary endoscopy, percutaneous via T-tube or other tract; diagnostic, with or without collection of specimen(s) by brushing and/or washing (separate procedure)
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#4
09-03-2009, 11:46 AM
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Thank you.
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