suela923@aol.com
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Can anyone tell me if the doctor must actually state the word cholangiogram for this to be billed as 47505, 74305? Or must he state that "pictures" were taken? Thanks so much for any input! Sue
Injection and removal of biliary drainage tube.
History: Malignant biliary obstruction. He is status post placement of a covered stent into the left intrahepatic biliary system by Dr. Connell. An and additional noncovered metallic stent was placed into right intrahepatic bile ducts earlier this week by Dr. Fearnow. An internal/external biliary drain was placed through the stent as a safety catheter. He returns today for injection and possible removal.
The previously placed internal/external biliary drainage tube was injected with contrast. Tube remains within bile ducts. It traverses the previously placed right-sided Wallstent. Contrast flowed into the stent, through the stent and eventually into the duodenum. The right-sided bile ducts are significantly less dilated on today's examination than they were on the pre-placement images.
This catheter was removed over a guidewire. An endhole catheter was inserted into the duodenum. This catheter was withdrawn during simultaneous injection of contrast into the stent to confirm patency of the stent. The stent was seen to be patent. There is rapid flow from the drained right intrahepatic bile ducts through the stent and into the duodenum. The entry tract into the liver was embolized using Gelfoam pledgets and autologous blood clot.
He tolerated the procedure well. There are no immediate complications. Film obtained at the end of the procedure demonstrated 2 metallic biliary stents in place. There have been complete removal of the biliary drainage catheter.
Injection and removal of biliary drainage tube.
History: Malignant biliary obstruction. He is status post placement of a covered stent into the left intrahepatic biliary system by Dr. Connell. An and additional noncovered metallic stent was placed into right intrahepatic bile ducts earlier this week by Dr. Fearnow. An internal/external biliary drain was placed through the stent as a safety catheter. He returns today for injection and possible removal.
The previously placed internal/external biliary drainage tube was injected with contrast. Tube remains within bile ducts. It traverses the previously placed right-sided Wallstent. Contrast flowed into the stent, through the stent and eventually into the duodenum. The right-sided bile ducts are significantly less dilated on today's examination than they were on the pre-placement images.
This catheter was removed over a guidewire. An endhole catheter was inserted into the duodenum. This catheter was withdrawn during simultaneous injection of contrast into the stent to confirm patency of the stent. The stent was seen to be patent. There is rapid flow from the drained right intrahepatic bile ducts through the stent and into the duodenum. The entry tract into the liver was embolized using Gelfoam pledgets and autologous blood clot.
He tolerated the procedure well. There are no immediate complications. Film obtained at the end of the procedure demonstrated 2 metallic biliary stents in place. There have been complete removal of the biliary drainage catheter.