Dx 239.0 denied for cpt 74305


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Clinical Indication: 62-year-old woman status post liver resection for cholangiocarcinoma who had 2 percutaneous transhepatic drainage catheters placed on the right for obstruction. Patient with recent episode of hematobilia. Cholangiogram through existing catheters for evaluation is requested.

Procedure: Cholangiogram through existing catheters, May 10, 2011

After informed consent was obtained, the patient was brought to the angiography suite and placed supine on the angiography table. The previously placed 2 right-sided internal/external biliary drainage catheters were aseptically prepared. Contrast was injected through each tube during fluoroscopic imaging.

Following the procedure the catheters were placed to gravity drainage and covered with sterile dressings.

The patient tolerated the procedure and left the angiography suite in stable condition.


During injection of each catheter there is opacification of the nondilated intrahepatic biliary system. There is immediate opacification of the hepatojejunostomy and jejunum. At no time during the injection of either catheter was extravasation of contrast to indicate leakage or opacification of blood vessels demonstrated.

During aspiration of the inferior-most catheter, blood was noted to fill the syringe. After several minutes the bleeding ceased.

Impression: No evidence for extravasation to indicate leakage or opacification of blood vessels.

Bleeding during the cholangiogram occurred but stopped after several minutes.