Biliary Coding Flows From Operative Report
Published on Sat Dec 01, 2001
Attention to detail in the operative report is vital to correctly reporting interventional procedures involving cholangiography and the biliary system. Coders must not only pair the appropriate procedure codes with radiological supervision and interpretation services (RS&I) but also pay close attention to global surgical periods and appropriate modifiers.
Interventional radiologists often diagnose and treat patients with conditions that interfere with the flow of bile through the biliary system. Obstructing lesions, including intraductal and extraductal tumors, inflammatory strictures and stones, can restrict flow between the liver, gallbladder, pancreas and the gastrointestinal tract, leading to dilatation of the ducts, infection and blood chemistry imbalances (e.g., 576.2, obstruction of bile duct). Radiologists employ a variety of therapeutic techniques to relieve pressure and correct the underlying condition, according to Gary Dorfman, MD, FACR, FSCVIR, past president of the Society for Cardiovascular and Interventional Radiology (SCVIR) and president of Health Care Value Systems in North Kingstown, R.I.
When diagnosing a suspected biliary condition after noninvasive imaging, radiologists will perform cholangiography, imaging studies to identify what is blocking or interfering with the normal flow of bile. Lisa Grimes, RT [R], radiology special procedures technologist and reimbursement specialist for the University of Texas/Houston Health Science Center, says one of two surgical codes and an RS&I code would be assigned for the study.
How To Report Imaging Studies
In one instance, the radiologist will insert a needle (with or without an intracatheter or sheath) directly into the biliary system, and bile will be aspirated and subsequently tested for infection, Grimes says. Then, contrast will be injected into the bile ducts and liver, and images obtained. This procedure would be reported with surgical CPT 47500 (injection procedure for percutaneous transhepatic cholangiography) and RS&I CPT 74320 (cholangiography, percutaneous, transhepatic, radiological supervision and interpretation).
At other times, this diagnostic procedure will be performed through an existing T-tube, which may have been inserted in the patient during an earlier surgical procedure, or through a previously placed percutaneous transhepatic drainage catheter. Dorfman notes that a T-tube is a device often implanted in the common bile duct intraoperatively to provide external drainage when the flow of bile is restricted. When imaging is performed through the T-tube, 47505 (injection procedure for cholangiography through an existing catheter [e.g., percutaneous transhepatic or T-tube]) is reported instead of 47500. RS&I code 74320 would again be assigned. Code 47500 has been assigned 1.96 work relative value units (RVUs), compared with 0.76 for 47505. This is understandable because 47505 is performed through an existing opening into the biliary system and requires less physician work "" he says.
While 47500 and 47505 are classified as diagnostic codes Dorfman says they are most frequently used prior to therapy. ""Often interventional radiologists perform cholangiography to obtain images and [...]
