chembree
Guru
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.
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.