mfournier
Networker
Hello fellow coders:
Was wondering if someone can take a peek at this note. I thought it would be 47563 but after reading an article from Karen Zupko Associates (Known as KZA) not sure if this is correct and perhaps it should be 47562. Op note is listed below and also the little clip from KZA
Procedure: Laparoscopic cholecystectomy with intraoperative fluoro-cholangiogram.
Interpretation of cholangiogram
Findings: A normal cholangiogram with flow into the duodenum, flow into the hepatic radicles, no obvious filling defects, and normal anatomy, somewhat limited by the patient's body habitus.
Procedure: The procedure was performed in the operating room. The patient was transferred to the operating table in the supine position. The patient was prepped and draped in standard surgical fashion. A periumbilical incision was made and carried down to the skin, subcutaneous tissues, to the fascia. The fascia was elevated and incision was made in the fascia. 0 Vicryl suture was placed to secure the trocar. The abdomen was entered bluntly and insufflated with CO2. Additional trochars were then placed in the epigastric, subcostal, and lateral positions. The gallbladder was grasped by its fundus, retracted cephalad. The infundibulum was retracted laterally. The cystic duct was dissected from its surrounding tissues, and clipped on the gallbladder side. A ductotomy was performed. A cholangiocatheter was placed followed by the cholangiogram. Please see the findings for details. 2 clips were then placed on the common bile duct side of the ductotomy on the cystic duct. The cystic duct was transected. The cystic artery was similarly dissected, clipped, and transected. The gallbladder was removed from the bed of the liver with a combination of blunt, sharp, electrocautery dissection techniques, placed in an Endopouch, and removed via the umbilical port site. The gallbladder fossa was irrigated and irrigant was suctioned, and when hemostasis was achieved, the abdomen desufflated and the ports removed. The umbilical port site was closed on the fascial level with the previously placed suture. All skin incisions were closed with 4-0 Monocryl. All incisions were dressed with Steri-Strips. The patient tolerated the procedure.
KZA Article
Can I report code 47563 when indocyanine green (ICG) dye is injected and then I use minimally invasive fluorescent imaging to view structures during dissection?
Answer:
No, it would not be correct to report code 47563 for this clinical scenario. Instead report code 47562, Laparoscopy, surgical; cholecystectomy. Although evaluation using fluorescent imaging may help to visualize structures, it does not confidently demonstrate choledocholithiasis, show the intrahepatic branches or see drainage into the duodenum like a traditional cholangiogram. It also does not include the additional work inherent to code 47563, including placement of a cholangio catheter, injection of radiographic contrast material while viewing the imaging monitor or review of plane films placed under the patient and exposed.
Thank you everyone
MF
Was wondering if someone can take a peek at this note. I thought it would be 47563 but after reading an article from Karen Zupko Associates (Known as KZA) not sure if this is correct and perhaps it should be 47562. Op note is listed below and also the little clip from KZA
Procedure: Laparoscopic cholecystectomy with intraoperative fluoro-cholangiogram.
Interpretation of cholangiogram
Findings: A normal cholangiogram with flow into the duodenum, flow into the hepatic radicles, no obvious filling defects, and normal anatomy, somewhat limited by the patient's body habitus.
Procedure: The procedure was performed in the operating room. The patient was transferred to the operating table in the supine position. The patient was prepped and draped in standard surgical fashion. A periumbilical incision was made and carried down to the skin, subcutaneous tissues, to the fascia. The fascia was elevated and incision was made in the fascia. 0 Vicryl suture was placed to secure the trocar. The abdomen was entered bluntly and insufflated with CO2. Additional trochars were then placed in the epigastric, subcostal, and lateral positions. The gallbladder was grasped by its fundus, retracted cephalad. The infundibulum was retracted laterally. The cystic duct was dissected from its surrounding tissues, and clipped on the gallbladder side. A ductotomy was performed. A cholangiocatheter was placed followed by the cholangiogram. Please see the findings for details. 2 clips were then placed on the common bile duct side of the ductotomy on the cystic duct. The cystic duct was transected. The cystic artery was similarly dissected, clipped, and transected. The gallbladder was removed from the bed of the liver with a combination of blunt, sharp, electrocautery dissection techniques, placed in an Endopouch, and removed via the umbilical port site. The gallbladder fossa was irrigated and irrigant was suctioned, and when hemostasis was achieved, the abdomen desufflated and the ports removed. The umbilical port site was closed on the fascial level with the previously placed suture. All skin incisions were closed with 4-0 Monocryl. All incisions were dressed with Steri-Strips. The patient tolerated the procedure.
KZA Article
Can I report code 47563 when indocyanine green (ICG) dye is injected and then I use minimally invasive fluorescent imaging to view structures during dissection?
Answer:
No, it would not be correct to report code 47563 for this clinical scenario. Instead report code 47562, Laparoscopy, surgical; cholecystectomy. Although evaluation using fluorescent imaging may help to visualize structures, it does not confidently demonstrate choledocholithiasis, show the intrahepatic branches or see drainage into the duodenum like a traditional cholangiogram. It also does not include the additional work inherent to code 47563, including placement of a cholangio catheter, injection of radiographic contrast material while viewing the imaging monitor or review of plane films placed under the patient and exposed.
Thank you everyone
MF