Report denied med nec Dx 239.0 for cpt 74305

she803

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Please advise--don't understand why report was denied--should dx on this report be coded differently? Thank you in advance.

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

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.

Findings:

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.
 

she803

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Physician billed dx originally for this report--i handle denials to rebill. thats why i was confused about this report.
 

she803

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Physician billed dx originally for this report--i handle denials to rebill. thats why i was confused about this report. Thats why i was wondering what other dx should this report be billed as?
 

mitchellde

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this is why physician selected codes need to be verified prior to claim submission.
the report states the patient has cholangiocarcinoma, and is post liver resection, the hematobilia is the reason for the study.
I would code for the hematobilia and the cholangiocarcinoma as a secondary dx. He does not state that the hematobilia is a complication of the surgery so you could not code it as a complication. I would also look for a V code for the status of the transhepatic drainage catheters, I am not sure there is one but I would look. 239.0 is not an appropriate code for this individual as that is a code used after a preliminary diagnostic study reveals a say a tumor that has yet to be determined as to benign, malignant, or uncertain.
 
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