iamlou
Networker
I haven't gotten any feedback on this so I'm resubmitting. Any thoughts would be greatly appreciated!
Hi Guys,
Can you please help me with this? It looks like there was a lot going on.
PROCEDURES PERFORMED:
CHOLANGIOGRAM, BRUSH BIOPSY DISTAL COMMON BILE DUCT, STONE EXTRACTION
UTILIZING BASKET AND BALLOON TECHNIQUE, CHOLANGIOPLASTY, REINSERTION OF
BILIARY DRAINAGE CATHETER VIA T-TUBE TRACT
IMAGING MODALITY UTILIZED:
Fluoroscopy
ACCESS SITE:
T-tube tract
CATHETER POSITION:
Common bile duct
CONTRAST UTILIZED: Nonionic contrast utilized.
TECHNIQUE: The indwelling tube was sterilely prepped and draped in standard fashion.
Contrast was injected. There is a large oval filling defect identified in
the distal common bile duct. There are several small rounded filling
defects identified nested at the level of the pigtail catheter within the
common bile duct above the biliary enteric junction. The latter were felt
to likely reflect air bubbles. Catheter removed over a guidewire. An 8
French sheath inserted across the common bile duct. Through this, the
distal common bile duct was subsequently brushed using a standard brush
biopsy technique. Subsequently a standard biliary basket was placed and
attempts were made at engaging the presumed choledocholith in the distal
common bile duct. Multiple attempts were performed at positioning the
choledocholith into the bowel. It was difficult to image the
choledocholith due to the radiolucency of the stone. Followup injections
demonstrate a persistent filling defect which appears smaller, this suggest
possible stone fracture and/or possible displacement of portions of the
stone into the duodenum. Subsequently additional techniques were performed
including balloon push technique across the distal common bile duct
utilizing 8 x 20 and 10 x 20 mm balloons. Finally, completion balloon
cholangioplasty was performed using a 12 mm balloon. Balloon inflations
were for 5 minutes x 3. Completion study demonstrates patency of the
common bile duct. There are filling defects within the common bile duct
however these may be blood, underlying stone is not excluded. The patient
will undergo followup cholangiogram. Over the guidewire the sheath was
removed, and a 12 French Dawson-Mueller was placed in the mid common bile
duct. Dressing applied.
FINDINGS:
Cholangiogram demonstrates oblong filling defect in the distal common bile
duct which likely reflects a retained stone/choledocholith. As described
above, various techniques including basket, push balloon, and
cholangioplasty were utilized to fragment the stone in attempt to displace
the stone into the duodenum. Several small rounded defects were evident
nested at the level of the biliary drainage catheter, the latter felt to
likely reflect gas bubbles. Brush biopsy conducted along the level of the
distal common bile duct narrowing. Drainage catheter reinserted. The
patient will undergo followup diagnostic cholangiography to assess results
and need for further intervention.
I thought these codes would be appropriate, but the 47552 is editing against the 47630. I got: 47530/75984, 47630/74327, 47552, 47505/74305. What do you think? Thanks in advance for any help!!
Hi Guys,
Can you please help me with this? It looks like there was a lot going on.
PROCEDURES PERFORMED:
CHOLANGIOGRAM, BRUSH BIOPSY DISTAL COMMON BILE DUCT, STONE EXTRACTION
UTILIZING BASKET AND BALLOON TECHNIQUE, CHOLANGIOPLASTY, REINSERTION OF
BILIARY DRAINAGE CATHETER VIA T-TUBE TRACT
IMAGING MODALITY UTILIZED:
Fluoroscopy
ACCESS SITE:
T-tube tract
CATHETER POSITION:
Common bile duct
CONTRAST UTILIZED: Nonionic contrast utilized.
TECHNIQUE: The indwelling tube was sterilely prepped and draped in standard fashion.
Contrast was injected. There is a large oval filling defect identified in
the distal common bile duct. There are several small rounded filling
defects identified nested at the level of the pigtail catheter within the
common bile duct above the biliary enteric junction. The latter were felt
to likely reflect air bubbles. Catheter removed over a guidewire. An 8
French sheath inserted across the common bile duct. Through this, the
distal common bile duct was subsequently brushed using a standard brush
biopsy technique. Subsequently a standard biliary basket was placed and
attempts were made at engaging the presumed choledocholith in the distal
common bile duct. Multiple attempts were performed at positioning the
choledocholith into the bowel. It was difficult to image the
choledocholith due to the radiolucency of the stone. Followup injections
demonstrate a persistent filling defect which appears smaller, this suggest
possible stone fracture and/or possible displacement of portions of the
stone into the duodenum. Subsequently additional techniques were performed
including balloon push technique across the distal common bile duct
utilizing 8 x 20 and 10 x 20 mm balloons. Finally, completion balloon
cholangioplasty was performed using a 12 mm balloon. Balloon inflations
were for 5 minutes x 3. Completion study demonstrates patency of the
common bile duct. There are filling defects within the common bile duct
however these may be blood, underlying stone is not excluded. The patient
will undergo followup cholangiogram. Over the guidewire the sheath was
removed, and a 12 French Dawson-Mueller was placed in the mid common bile
duct. Dressing applied.
FINDINGS:
Cholangiogram demonstrates oblong filling defect in the distal common bile
duct which likely reflects a retained stone/choledocholith. As described
above, various techniques including basket, push balloon, and
cholangioplasty were utilized to fragment the stone in attempt to displace
the stone into the duodenum. Several small rounded defects were evident
nested at the level of the biliary drainage catheter, the latter felt to
likely reflect gas bubbles. Brush biopsy conducted along the level of the
distal common bile duct narrowing. Drainage catheter reinserted. The
patient will undergo followup diagnostic cholangiography to assess results
and need for further intervention.
I thought these codes would be appropriate, but the 47552 is editing against the 47630. I got: 47530/75984, 47630/74327, 47552, 47505/74305. What do you think? Thanks in advance for any help!!