General Surgery Coding Alert

Question: Which is the correct code to describe "radiologic examination of the bile ducts" when performed with cholecystectomy?

Minnesota Subscriber

Answer: The appropriate code to describe cholecystectomy with cholangiography (radiologic examination of the bile ducts) is 47563 (Laparoscopy, surgical; cholecystectomy with cholangiography) for laparoscopic approach or 47605 (Cholecystectomy; with cholangiography) for an open procedure.

Many surgeons perform cholangiography as a standard component of cholecystectomy, and you must be careful to discern the cholangiography in the operative report. Because the surgeon considers the cholangiography routine, he may fail to note the procedure in the operative report summary.

But if the surgeon performs both cholangiography and exploration of the common bile duct (to locate and remove gallstones, for instance), you should report only 47564 (Laparoscopy, surgical; cholecystectomy with exploration of common duct) for laparoscopic approach or 47610 (Cholecystectomy with exploration of common duct) for an open procedure.

Explanation: The national Correct Coding Initiative bundles 47563 into 47564 and likewise includes 47605 in 47610. Both edits include a "0" modifier indicator, meaning that you may never override them. Payers will always include the work involved in cholangiography in exploration of the common ducts.