General Surgery Coding Alert

Avoid ‘stent’ terminology for emptying bile duct.

With five new codes and a host of new instructions, you need to understand the CPT^® 2016 code options for reporting catheter placement, exchange, or removal when your surgeon performs a procedure to manage bile-duct drainage.

Follow our three expert tips to make sure you know how to use the new drainage codes, when to rely on some existing E/M codes, and how to keep the drainage codes straight with the host of other new CPT^® 2016 biliary procedure codes.

Tip 1: Pick One Code for Placement

When your surgeon percutaneously places a biliary drainage catheter, you have two new codes based on whether the catheter drains internally or externally, as follows:

• 47533 — Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; external
• 47534 — … internal-external

Understand internal/external distinction: “When the surgeon percutaneously places a catheter in the bile duct to drain bile outside the body, that’s a 47533 service,” explains Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, internal audit manager with PeaceHealth in Vancouver, Wash. “On the other hand, if the bile-duct catheter is externally accessible and drains bile into the small intestine, or possibly into the small intestine and also externally, you should report 47534,” she says.

Clarification: You may be used to calling a biliary drainage catheter a “stent,” but that’s not appropriate terminology any more. “Because CPT^® now has a host of new biliary codes to describe ‘stents’ that are internal metal prostheses, clarity dictates that you no longer use the term to describe a drainage catheter,” Bucknam explains. See “Nail Your Percutaneous Biliary Stent Coding With 4 Tips” in General Surgery Coding Alert Vol 18 No 5 for a full discussion of the new stent codes.

Includes all: Notice from the 47533-47534 code definitions that the procedure includes diagnostic cholangiography when performed, as well as any imaging guidance (such as ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation (S&I). Don’t report separate code(s) for those services.

Tip 2: Focus Exchange/Conversion Coding

If your surgeon exchanges an existing percutaneous biliary drainage catheter with a new one — of either the same or different type (external versus internal/external) — CPT^® 2016 has some new codes for you to use to describe that service.

As with the new catheter placement codes, the following two new biliary catheter exchange codes include all imaging guidance and interpretation, when provided:

• 47535 — Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (e.g., fluoroscopy), and all associated radiological supervision and interpretation
• 47536 — Exchange of biliary drainage catheter (e.g., external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (e.g., fluoroscopy), and all associated radiological supervision and interpretation.

Exchange code 47536 refers to replacing a biliary drainage catheter with the same type, or converting a more complicated catheter (internal-external) to a simpler one (external only).

Reserve the ‘conversion’ code 47535 for cases when the surgeon replaces an external catheter with an internal-external biliary catheter. “Converting from external-only to an internal-external catheter is a more complex procedure, which is why CPT^® provides a distinct code for that specific replacement scenario,” Bucknam explains.

Avoid costly mistake: That’s also why Medicare pays more for 47535 ($1125.69) than for 47536 ($830.66) (non-facility national limit amount, conversion factor 35.8043). In other words, using the wrong code could cost you $295.

Watch units: Code 47536 describes the exchange of a single catheter. But what if the surgeon exchanges the catheter more than one time during the operative session? “CPT^® instructs you to report one unit of 47536 for each biliary catheter exchange, and to report each exchange beyond the first one with modifier 59 (Distinct procedural service),” Bucknam says.

Tip 3: Check Out Removal Options

When the surgeon removes a percutaneous biliary drainage catheter, CPT^® 2016 provides you with one new code, as follows — but that doesn’t mean it’s your only code choice:

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

“Use this code only if the removal requires fluoroscopic guidance. Otherwise, turn to an appropriate E/M code such as 99211-99215 for an established office or outpatient visit,” Bucknam says.