Wiki biliary procedure/ co-suergeons?

chembree

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The below procedure was performed by one of our radiologist in conjunction with a gastroenterologist physician. Going by this dictation what can I bill? I see the cholangiogram (74320 & 47500) but I am not sure about billing the catheterization. Also, I see a 62 modifier is allowed for 47500. Should I use a 62 modifier in this case on all my surgical codes?

Indication: Pancreatic mass causing common bile duct obstruction, biliary ductal dilatation and jaundice.

Procedure: Informed consent was obtained. In the operating room, the patient was placed in the supine position and prepped and draped in a sterile technique. Whole-body sterile drape, sterile gown, sterile gloves, surgical and facemask were utilized for the procedure.

Anesthesia was utilized.

Under ultrasound guidance, a 22-gauge access needle was advanced from a right lateral abdominal wall approach and into the right hepatic lobe. This needle was guided into a slightly dilated right hepatic biliary duct. Ultrasound images were sent to PACS for documentation.
This was followed by injection of contrast through the access needle into the biliary system for a percutaneous cholangiogram. The percutaneous cholangiogram demonstrates intra and extra extrahepatic biliary ductal dilatation due to a mid to distal common bowel duct obstruction. The common bile duct obstruction correlates with the pancreatic neoplasm on MRI of the abdomen performed on 3/26/2014.
Therefore, a guidewire was advanced through the access needle into the biliary system under fluoroscopic guidance. The needle was removed and an AccuStick sheath was deployed over the guidewire and into the biliary system with the tip in the proximal common bile duct under fluoroscopic guidance. The guidewire and AccuStick dilator was removed. A 5 French selective catheter was deployed through the AccuStick sheath. A 0.035 angled Glidewire was deployed through the selective catheter and into the proximal common bile duct. The Glidewire and selective catheter was advanced across the common bile duct obstruction/high-grade stenosis. The catheter and Glidewire were advanced through the ampulla and into the duodenum. The Glidewire and catheter was utilized by Dr. (Gastroenterology) during endoscopy for ERCP and placement of common bile duct stent. Please refer to the endoscopy report for continued/further detail. Approximately 13 minutes of fluoroscopic time was utilized.

Impression:

Mid to distal common bile duct obstruction/high-grade stenosis due to pancreatic head mass.

Ultrasound and fluoroscopic guided percutaneous cholangiogram.

Ultrasound and fluoroscopic guided placement of guidewire and selective catheter across common bile duct obstruction and into the duodenum.
 
Hello, EncoderPro does not show modifier 62 allowed for 47500. According to the op report, the gastroenterologist went on to perform ERCP with placement of endoscopic stent into biliary or pancreatic duct (CPT 43274). This code includes pre- and post-dilation and guide wire passage, when performed. CPT 43274 also does not allow modifier 62 per EncoderPro. It doesn't look like co-surgeon modifier 62 is going to be appropriate. The gastroenterologist may bill with modifier 52 since the radiologist performed part of the procedure.

For the catheterization & guidewire placement across the "obstruction/high-grade stenosis" of the common bile duct through the ampulla and into the duodenum, you may need to use CPT 47999 - unlisted procedure, biliary tract. An Accustick dilator was also used. The anatomy was affected by the pancreatic mass. The payer would need to review the op report to determine reimbursement.

Someone else may have additional thoughts on this case.


Jean Kayser CPC CIRCC
 
You are correct about modifier 62. I saw it on the fee schedule lookup tool that I have and did not pay attention to it saying, 62 is not permitted.


CPT? Code 47500 Details
Code Descriptor
Injection procedure for percutaneous transhepatic cholangiography
Notes:
0 (For radiological supervision and interpretation, use 74320)
Lay Term
Clinical Responsibility
The patient is placed supine on the procedure table and prepped and draped in sterile fashion. The
needle is passed deeply into the liver substance and then slowly withdrawn, injecting the contrast
medium to locate a biliary radical . Radiological guidance is used to guide the needle and then to
take a study of the ducts.
This procedure is performed to evaluate tumor, upper abdominal pain, jaundice and to remove
blockage.
Terminology
Cholangiography is radiological examination of bile duct using contract
CPT?Guidelines
Code Specific Guideline
(For cholangiography, see 47500, 74320)
ICD-9 Vol1 Crossref
156.1, 156.2, 156.9, 157.9, 195.2, 211.5, 239.9, 573.4, 573.8, 574.21, 574.31, 574.41, 574.61,
574.71, 574.81, 575.11, 575.12, 575.2, 575.4, 575.5, 575.6, 575.8, 576.1, 576.2, 576.3, 576.4,
576.8, 751.69, 782.4, V45.89,
? Copyright 2013-2014 www.aapc.com
CPT ? 2013 American Medical Association. All rights reserved.
Fee Schedule
Medicare Fees
National Adjusted 26 TC
Facility 100.66 100.66 0.00 0.00
Non Facility 100.66 100.66 0.00 0.00
RVU - Nonfacility
National Adjusted 26 TC
Work RVU: 1.96 1.96
PE RVU: 0.66 0.66
Malpractice RVU: 0.19 0.19
Total RVU: 2.81 2.81 0 0
RVU - Facility
National Adjusted 26 TC
Work RVU: 1.96 1.96
PE RVU: 0.66 0.66
Malpractice RVU: 0.19 0.19
Total RVU: 2.81 2.81 0 0
Global & Other Info
Global Split
Preoperative %: 0
Intraoperative %: 0
Postoperative %: 0
Total RVU: 0
Global Period (days): 000
Radiology Diagnostic Tests : 99
Code Status : A
PC/TC Indicator : 0
Endoscopic Base Code : None
? Copyright 2013-2014 www.aapc.com
CPT ? 2013 American Medical Association. All rights reserved.
Medically Unlikely Edit (MUE) : 2
Modifier Guidelines
Modifier Rules(Click on rules for Details)
MULT PROC 51 Multiple procedure reduction applies
BILAT SURG 50 No 150% bilateral payment boost
ASST SURG 80 Assistant payment not allowed
CO-SURG 62 Co-surgeons not permitted
TEAM SURG 66 Team surgeons not permitted
MINIMUM ASST SURG 81 Assistant payment not allowed.
ASST SURG (QUALIFIED RESI. NA) 82 Assistant payment not allowed.
PHYSICIAN
 
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