Wiki ICG (Indocyanine green)

KoBee

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Hello everyone -

is anyone familiar with the correct CPT code to use for ICG during cholecystectomy? done some research and states it may be integral to main procedure but then I read that you can code it separately, a bit confused, appreciate any feedback.

I have providers trying to use 99240 but I feel that is incorrect as it is an ophthalmology code.

Thank you
 
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No experience with ICG during cholecystectomy, only for sentinel lymph node identification during hysterectomy.
If you are performing it for sentinel lymph node identification, 38900 describes exactly the procedure, but is an add on code and you must also bill one of the base codes. If done bilaterally, bill with both -RT and -LT. If you are not billing one of the base codes, then use unlisted 38999 comparing to the work of 38900.
38900 Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure)
Notes: (Use 38900 in conjunction with 19302, 19307, 38500, 38510, 38520, 38525, 38530, 38531, 38542, 38562, 38564, 38570, 38571, 38572, 38740, 38745, 38760, 38765, 38770, 38780, 56630, 56631, 56632, 56633, 56634, 56637, 56640)
If you are NOT doing the ICG injection for sentinel lymph node identification, then the link from the first post gives some alternative codes depending on what you are doing the procedure for.
 
Indocyanine (ICG) or Firefly TM fluorescence is bundled into the cholecystectomy and is not separately billable.
 
With a LAP cholecystectomy (47562 or 47563), I have been able to bill 74300,26. It is not separately reportable with any of the colon resections.
 
Indocyanine (ICG) or Firefly TM fluorescence is bundled into the cholecystectomy and is not separately billable.
do you by any chance have reference/resource to this, I need to send something to providers so they don't think i'm making this up.
 
With a LAP cholecystectomy (47562 or 47563), I have been able to bill 74300,26. It is not separately reportable with any of the colon resections.
do you by any chance have reference/resource to this, I need to send something to providers so they don't think i'm making this up.
 
When I researched the billing of ICG with Cholecystectomy I found that Anesthesia bills for this. We cannot bill this as it is included in the 47562 and 47563. I would check with your Anesthesia Department and see if they are billing this. Hope this helps.
 
Here's a reference, KoBee . . .

According to the online publication “General Surgery Coding Coach” . . .

Billing for “Icy Green” Dye

October 15, 2020

Question:
The surgeon did a robotic/laparoscopic cholecystectomy and cholangiogram with icy green and firefly identification of biliary anatomy. He billed a 47563. Can he can bill separately for the icy green and firefly dye?

Answer:
Billing for indocyanine (ICG) or Firefly TM fluorescence is bundled into 47563 laparoscopic cholecystectomy with cholangiogram and is not separately billable.

*This response is based on the best information available as of 10/15/20.

https://www.karenzupko.com/billing-for-icy-green-dye/

Hope this helps!
 
Plz check out this for cholecystectomy with ICG or firefly.

CLARIFICATION

Coding Clinic for HCPCS First Quarter 2022, pages 9-10, advised to report CPT code 47563, Laparoscopy, surgical; cholecystectomy with cholangiography, for a laparoscopic cholecystectomy with intraoperative fluorescence imaging using indocyanine green (ICG) dye. Research indicates that an intraoperative cholangiogram (IOC) requires insertion of a cholangiocatheter into the cystic duct with direct injection of radiographic contrast. However, in the published example, cholangiocatheter insertion into the cystic duct with injection of radiographic contrast was not documented. We believe imaging with ICG dye is not analogous to an IOC. We are asking Coding Clinic for HCPCS to revisit this advice.



ANSWER

In that case, the provider documented, "Indocyanine green dye was administered as well for intraoperative fluorescent cholangiogram." However, after further review, the description of the procedure did not indicate the ICG imaging visualized the bile ducts but rather it was used only to visualize the common bile and cystic duct insertions to aid in dissection. Visualization of structures with ICG to aid with dissection is not analogous to an intraoperative cholangiogram. Therefore, assign CPT code 47562, Laparoscopy, surgical; cholecystectomy, for the laparoscopic cholecystectomy. Continue to report HCPCS Level II add-on code C9776, Intraoperative near-infrared fluorescence imaging of major extra-hepatic bile duct(s) (e.g., cystic duct, common bile duct and common hepatic duct) with intravenous administration of indocyanine green (ICG) (list separately in addition to code for primary procedure), to identify the use of the ICG imaging technology.



The Central Office on HCPCS apologizes for any confusion the previous advice may have caused.
 
I have been able to bill 74300,26 with Lap Chol ...Medicare has paid it, UHC has not.
@Peterk50 keep in mind that just because you are being paid for something doesn't mean you should've been paid for it, and that the payer may come back and recoup the money if they find the services weren't separately reportable/billable.
 
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