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alligator biopsy-cytologic brushings biopsy??

  1. #1
    Default alligator biopsy-cytologic brushings biopsy??
    Medical Coding Books
    How would you code the biopsies on this procedure?

    PERCUTANEOUS BILIARY DRAIN CATHETER:

    INDICATION: Intrahepatic ductal dilatation, hyperbilirubinemia,
    suspected neoplastic stricture at confluence of left and right
    intrahepatic ducts.

    PROCEDURE/FINDINGS: After informed consent was obtained, under sterile
    conditions and administration local anesthetic, a 21-gauge needle was
    used to puncture the right dilated biliary radical. An .018 guidewire
    was inserted. The .018 guidewire did traverse the tight stenosis related
    to stricture. Next, a transitional catheter set was used. An .035
    guidewire was utilized. An 8-French sheath was placed through which
    cytologic brushings were made across a stricture in addition to an
    alligator biopsy device being used to obtain tissue, placed in formalin.
    Over a guidewire, an 8-French pigtail internal/external biliary drain
    was placed and connected to gravity drainage bag and secured to the
    patient's skin.

    The patient was provided Versed and fentanyl given intravenously for
    adequate conscious sedation during the procedure.

    IMPRESSION:

    1. Internal/external biliary drain placement following biliary stricture
    cytologic brushings and forceps biopsy of stricture.

    2. The patient may need a left-sided drain for further decompression if
    bilirubin does not improve significantly with this internal/external
    drain.
    Last edited by chembree; 07-13-2009 at 12:53 PM. Reason: CORRECT SPELLING

  2. #2
    Default Biopsy code
    Quote Originally Posted by c422rad View Post
    How would you code the biopsies on this procedure?

    PERCUTANEOUS BILIARY DRAIN CATHETER:

    INDICATION: Intrahepatic ductal dilatation, hyperbilirubinemia,
    suspected neoplastic stricture at confluence of left and right
    intrahepatic ducts.

    PROCEDURE/FINDINGS: After informed consent was obtained, under sterile
    conditions and administration local anesthetic, a 21-gauge needle was
    used to puncture the right dilated biliary radical. An .018 guidewire
    was inserted. The .018 guidewire did traverse the tight stenosis related
    to stricture. Next, a transitional catheter set was used. An .035
    guidewire was utilized. An 8-French sheath was placed through which
    cytologic brushings were made across a stricture in addition to an
    alligator biopsy device being used to obtain tissue, placed in formalin.
    Over a guidewire, an 8-French pigtail internal/external biliary drain
    was placed and connected to gravity drainage bag and secured to the
    patient's skin.

    The patient was provided Versed and fentanyl given intravenously for
    adequate conscious sedation during the procedure.

    IMPRESSION:

    1. Internal/external biliary drain placement following biliary stricture
    cytologic brushings and forceps biopsy of stricture.

    2. The patient may need a left-sided drain for further decompression if
    bilirubin does not improve significantly with this internal/external
    drain.
    Use 47552 - Choleangioscopy, perc., w/ or w/o brushing or washing
    and 47553 - Choleangioscopy, perc. with biopsy

  3. Default
    My codes are,

    47511
    47552
    75982
    99144

    You may need to clarifiy whether to code an Unlisted procedure for aligator biopsy of the stricture.

    Elamathi

  4. #4
    Default
    I seen the 47552 and 47553 but did not think I could use them because they includes endoscopy?
    Last edited by chembree; 07-14-2009 at 05:59 AM. Reason: add more info

  5. #5
    Default
    Quote Originally Posted by c422rad View Post
    I seen the 47552 and 47553 but did not think I could use them because they includes endoscopy?
    According to SIR, Cpt editorial panel and CMS states that "endoscopy codes" are considered accurate for discribing codes 47552 - 47556, done either endoscopically or percutaneously.

  6. #6
    Default
    That is very helpful! Can you send me the link to this information so that I can show this to the other coders in the office!


    Thanks so much!
    Christy Hembree,CPC

  7. #7
    Default
    Quote Originally Posted by c422rad View Post
    That is very helpful! Can you send me the link to this information so that I can show this to the other coders in the office!


    Thanks so much!
    Christy Hembree,CPC
    I found the info in the Society of Interventional Radiology's Coding Users' Guide on Pgs. 126-7 on the use of "scopy" codes.

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