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biliary catheter to internal/external biliary catheter

  1. #1
    Default biliary catheter to internal/external biliary catheter
    Exam Training Packages
    What code do I use for Internalization of the left biliary catheter to internal/external biliary drainage catheter???

    This is a copy of the report...

    So far these are my codes...
    47505
    47505
    47525
    74305
    74305
    75984
    ????
    ????
    99144
    Exam:
    1. Right cholangiogram through existing catheter
    2. Left cholangiogram through existing catheter
    2. Exchange of right-sided internal/external biliary catheter.
    3. Internalization of the left biliary catheter to internal/external
    biliary drainage catheter.

    Catheters: Two 8 French internal/external biliary drainage catheters.

    MEDICATION: Local and conscious sedation. 4.5 grams Zosyn IV also
    administered.

    TECHNIQUE: The risks, benefits and procedure itself were explained to
    the patient and informed written consent was obtained. The patient was
    placed on the table in the supine position. Bilateral existing tubes and
    overlying skin was cleaned and draped in sterile fashion. First the
    right-sided catheter was injected with contrast. A superstiff Amplatz
    wire was then advanced to the catheter into the small bowel. Catheter
    was removed and wire secured. The left biliary drainage catheter was
    then injected, unlocked, and a superstiff Amplatz wire advanced.
    Catheter removed and 8 French vascular sheath was placed. Using
    combination of a stiff angled Glidewire and a Kumpe catheter, the
    Glidewire was advanced through the area of tight stenosis and into the
    small bowel. The Kumpe catheter was then advanced and a wire exchanged
    for a superstiff Amplatz wire. The Kumpe catheter and sheath were then
    removed. Prior to removal, extension in the small bowel was confirmed
    with injection of contrast through the Kumpe catheter. The kidney sheath
    and the catheter were removed and wire secured. 8 French
    internal/external biliary drainage catheter was then advanced over the
    right wire into the duodenum. Secondly the left 8 French
    internal/external biliary catheter was advanced. Both pigtails were
    formed and proximal side holes positioned appropriately. Both catheters
    were sutured in place using 2-0 silk. Adhesive device used to secure
    catheters. Patient tolerated the procedure well without post procedural
    complication.

    FINDINGS:
    1. Initial cholangiogram demonstrated nondilated right biliary system.
    Contrast extended into the small bowel primarily about the catheter.
    Again, tight narrowing is seen involving the distal right common bile
    duct.

    2. Left biliary cholangiogram. The left biliary ductal system has
    markedly decreased in dilatation from prior examination with only mild
    residual dilatation. Contrast is seen to extend laterally filling a
    right hepatic duct as well as extending into the common bile duct. There
    is tight stenosis at this involving the distal left hepatic duct,
    however, contrast does extend through this region.

    3. Multiple images demonstrating positioning of wires through both
    systems into the duodenum with biliary catheters appropriately
    positioned.

    4. Contrast injection for both wire placement and final positioning of
    the pigtail catheter was documented.

    IMPRESSION:

    1. Tight stenosis involving the distal right and distal left hepatic
    duct consistent with patient's known Klatskin's tumor.

    2. Bilateral decompressed biliary systems.

    3. Successful exchange of the right-sided internal/external biliary
    drainage catheter.

    4. Successful internalization of the left biliary drainage catheter.

    PLAN:

    1. Patient will be drained by gravity bag for 24 hours and then capped
    for internal drainage.

    2. Recommend flushing biliary drainage catheters b.i.d. with normal
    saline 10 mL, do not aspirate.

    3. Patient will return for biliary drain check change every 6 weeks.
    Discussion of internal stents should be made prior to next exchange so
    this can be performed at that time.
    Last edited by chembree; 08-04-2009 at 02:10 PM. Reason: add a code

  2. #2
    Default
    Quote Originally Posted by c422rad View Post
    What code do I use for Internalization of the left biliary catheter to internal/external biliary drainage catheter???

    This is a copy of the report...

    So far these are my codes...
    47505
    47505
    47525
    74305
    74305
    75984
    ????
    ????
    99144
    Exam:
    1. Right cholangiogram through existing catheter
    2. Left cholangiogram through existing catheter
    2. Exchange of right-sided internal/external biliary catheter.
    3. Internalization of the left biliary catheter to internal/external
    biliary drainage catheter.

    Catheters: Two 8 French internal/external biliary drainage catheters.

    MEDICATION: Local and conscious sedation. 4.5 grams Zosyn IV also
    administered.

    TECHNIQUE: The risks, benefits and procedure itself were explained to
    the patient and informed written consent was obtained. The patient was
    placed on the table in the supine position. Bilateral existing tubes and
    overlying skin was cleaned and draped in sterile fashion. First the
    right-sided catheter was injected with contrast. A superstiff Amplatz
    wire was then advanced to the catheter into the small bowel. Catheter
    was removed and wire secured. The left biliary drainage catheter was
    then injected, unlocked, and a superstiff Amplatz wire advanced.
    Catheter removed and 8 French vascular sheath was placed. Using
    combination of a stiff angled Glidewire and a Kumpe catheter, the
    Glidewire was advanced through the area of tight stenosis and into the
    small bowel. The Kumpe catheter was then advanced and a wire exchanged
    for a superstiff Amplatz wire. The Kumpe catheter and sheath were then
    removed. Prior to removal, extension in the small bowel was confirmed
    with injection of contrast through the Kumpe catheter. The kidney sheath
    and the catheter were removed and wire secured. 8 French
    internal/external biliary drainage catheter was then advanced over the
    right wire into the duodenum. Secondly the left 8 French
    internal/external biliary catheter was advanced. Both pigtails were
    formed and proximal side holes positioned appropriately. Both catheters
    were sutured in place using 2-0 silk. Adhesive device used to secure
    catheters. Patient tolerated the procedure well without post procedural
    complication.

    FINDINGS:
    1. Initial cholangiogram demonstrated nondilated right biliary system.
    Contrast extended into the small bowel primarily about the catheter.
    Again, tight narrowing is seen involving the distal right common bile
    duct.

    2. Left biliary cholangiogram. The left biliary ductal system has
    markedly decreased in dilatation from prior examination with only mild
    residual dilatation. Contrast is seen to extend laterally filling a
    right hepatic duct as well as extending into the common bile duct. There
    is tight stenosis at this involving the distal left hepatic duct,
    however, contrast does extend through this region.

    3. Multiple images demonstrating positioning of wires through both
    systems into the duodenum with biliary catheters appropriately
    positioned.

    4. Contrast injection for both wire placement and final positioning of
    the pigtail catheter was documented.

    IMPRESSION:

    1. Tight stenosis involving the distal right and distal left hepatic
    duct consistent with patient's known Klatskin's tumor.

    2. Bilateral decompressed biliary systems.

    3. Successful exchange of the right-sided internal/external biliary
    drainage catheter.

    4. Successful internalization of the left biliary drainage catheter.

    PLAN:

    1. Patient will be drained by gravity bag for 24 hours and then capped
    for internal drainage.

    2. Recommend flushing biliary drainage catheters b.i.d. with normal
    saline 10 mL, do not aspirate.

    3. Patient will return for biliary drain check change every 6 weeks.
    Discussion of internal stents should be made prior to next exchange so
    this can be performed at that time.
    You have most of the codes correct, but the wonderful modifiers needed to be added. I would use:
    47505/74305 for the right side catheter
    47505-59/ 74305-59 for the left side catheter
    47525-rt/ 75984 -rt for exchange of rt side catheter
    47511-lt/ 75982 lt - for internalization of the left side catheter
    99144 sedation for the first 1/2 hour
    99145 (?) sedation for each additional 15 mins. The doctor did not say how long the sedation period was but the doctor needs to be asked, because I know this case probably did not take only 1/2 hours. This need to be asked so you don't lose the money for the procedure

    I hopes this helps you out,
    Jim Pawloski R.T.(CV) CIRCC

  3. #3
    Default
    Thank you for your help!

  4. #4
    Default
    Thanks both of you Christy and Jim.

  5. #5
    Question pigtail drain removal
    I'm hoping you can help me with coding the removal of a pigtail drain. It would probably be considered as part of the surgical procedure but Dr M.
    is not the same physician that did the surgery. The patient had surgery in Tucson and was transferred to a skilled nursing facility in Sierra Vista. The patient is being followed by their family practice physician. Dr M. had to remove the drain but I don't know if he can be paid for it. I can't find a code. Please help.

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