Identify an RS&I Code for Intraoperative Cholangiography
Question: During a laparoscopic cholecystectomy, the surgeon performed an intraoperative cholangiogram due to the patient’s dilated common bile duct and prior enzyme elevation. The surgeon cannulated the cystic duct, injected contrast under fluoroscopy, and documented the interpretation — normal intrahepatic and extrahepatic ducts with free flow into the duodenum and no filling defects. The surgeon noted chronic calculous cholecystitis without choledocholithiasis. Pathology confirmed chronic cholecystitis with cholelithiasis. How do we report this encounter? North Dakota Subscriber Answer: Assign 47563 (Laparoscopy, surgical; cholecystectomy with cholangiography) to report the laparoscopic cholecystectomy with cholangiography. You noted the surgeon also performed a cholangiogram during the procedure, which is covered by 47563. Use 74300 (Cholangiography and/or pancreatography; intraoperative, radiological supervision and interpretation) appended with modifier 26 (Professional component) to report the intraoperative cholangiography radiological supervision and interpretation (RS&I). Appending modifier 26 to 74300 shows that the surgeon performed the interpretation of the images. It is crucial that the operative note includes documented interpretation of the images in order to report the professional component of the RS&I procedure. If the record does not include the interpretation, you’ll report just 47563 for the procedure. Next, turn to the ICD-10-CM code book to select the correct diagnosis code. For this case, you’ll assign K80.10 (Calculus of gallbladder with chronic cholecystitis without obstruction) to report the chronic cholecystitis with cholelithiasis without obstructions diagnosis. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
