Wiki Biliary Drain vs. Abscess Drain

[Jim Pawloski]

Pt has a biliary obstruction. A chiba needle in placed in the left biliary duct, and is injected. Choleangiogram was performed showing obstruction of the biliary tree near the central left main biliary duct. No filling of the biliary duct, however, a communication with the abscess is noted. A 12f drainage catheter was placed into to collection after the tract was dilated. The catheter was injected and demonstrates a large RUQ collection. The tube was then exchanged for for a 14 f. drainage catheter. Catheter was injected and contrast was flowing into the biloma. Catheter was secured and placed to gravity drainage.
Do I code for a PTC (47532) and a external drainage (47533) and a catheter drain exchange? Or do I code for a 49405?
Thanks,
Jim Pawloski, CIRCC

 

[daniel]

I wouldn't use 49405 here, and the other codes bundle. Since it through the same access point, looks like your left with 47533.

In 47533, the physician introduces a catheter into the liver to drain fluid using ultrasound and/or fluoroscopy to guide the process. The puncture site on the right side of the body is incised, the needle inserted between the ribs, advanced into the liver, and into the bile duct. Contrast medium is injected to visualize the intrahepatic bile ducts. A guidewire is inserted and advanced to the point of obstruction through an optimal duct permitting access and drainage. A catheter is threaded over the guidewire and dilators may be used to enlarge the opening and the tract from the skin to the bile duct. The drainage catheter is inserted and positioned above the point of the obstruction and secured to the skin. All of the bile drains out of the body through the catheter and into a collection bag. Occasionally, the use of two separate catheters is necessary to drain the right and left biliary duct systems.