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Biliary stent placement

  1. #1
    Default Biliary stent placement
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    Hi all,

    Pls confirm my codes...

    47556
    47525
    47505
    74363
    75984
    74305

    576.2

    I am not sure to code 47556 and 47525 together. Please clarify

    BILIARY STENT PLACEMENT
    CLINICAL HISTORY:
    THE PATIENT WOMAN WITH NEWLY DIAGNOSED PANCREATIC HEAD
    ADENOCARCINOMA CAUSING BILIARY DUCT OBSTRUCTION. THE PATIENT PREVIOUSLY
    UNDERWENT PLACEMENT OF AN INTERNAL AND EXTERNAL BILIARY DRAINAGE CATHETER
    ON JULY 28, 2009. PLACEMENT OF AN INTERNAL COMMON BILE DUCT STENT FOR
    INTERNALIZATION IS INDICATED WITH MODERATE SEDATION.
    PROCEDURE:
    THE PATIENT PROVIDED SIGNED INFORMED CONSENT PRIOR TO THE PROCEDURE. THE
    PATIENT WAS BROUGHT TO THE ANGIOGRAPHY SUITE, AND HER RIGHT UPPER QUADRANT
    WAS PREPPED AND DRAPED IN THE USUAL STERILE FASHION. SPOT FILM DEMONSTRATED
    THE INTERNAL-EXTERNAL DRAIN IN PLACE. A BENTSON WIRE WAS ADVANCED THROUGH
    THE CATHETER INTO THE JEJUNLJN AND THE INTERNAL-EXTERNAL DRAIN WAS REMOVED.
    A VER CATHETER WAS ADVANCED OVER THE WIRE INTO THE DUODENUM. THE BENTSON
    WIRE WAS EXCHANGED FOR AN AMPLATZ STIFF WIRE, ADVANCED INTO THE JEIYUNUM.
    THE CATHETER WAS REMOVED. A 10-FRENCH SHEATH WAS ADVANCED TO APPROXIMATELY
    THE AMPULLA. MULTIPLE INJECTIONS OF CONTRAST WERE PERFORMED TO ELUCIDATE
    THE BILIARY OBSTRUCTION LEVEL AND LENGTH FOR STENT SELECTION. A SMART STENT
    10 MM X 8 CM STENT CHOSEN AND WAS ADVANCED OVER THE WIRE INTO THE COMMON
    DUCT. THE STENT WAS DEPLOYED IN APPROPRIATE POSITION. A REPEAT
    CHOLANGIOGRAN WAS PERFORMED. WITH THE WIRE IN PLACE, A NEW INTERNAL-
    EXTERNAL DRAIN WAS ADVANCED AND POSITIONED APPROPRIATELY WITH THE DISTAL
    COILED TIP IN THE DUODENUM. THE TUBE WAS CAPPED. THE TUBE WAS SUTURED IN
    PLACE.
    DISCUSSION:
    1. INITIAL CHOLANGIOGRAM DEMONSTRATES A LONG-SEGMENT SMOOTH STENOSIS OF
    THE COMMON BILE DUCT.
    2. POST-STENTING CHOLANGIOGRAM DEMONSTRATES EXCELLENT CHOLANGIOGRAPHIC
    RESULT WITH NO PERSISTENT WASTING. NOT MENTIONED ABOVE WAS DILATION OF
    THE STENT WITH 10 MM BALLOON.
    IMPRESSION:
    TECHNICALLY SUCCESSFUL DEPLOYMENT OP A 10 MM X 8 CM SMART STENT WITHIN A
    STENOTIC REGION OF THE PATIENT’S COMMON BILE DUCT. A NEW INTERNAL-EXTERNAL
    DRAIN WAS PLACED AT THE CONCLUSION OF THE PROCEDURE.

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by prabhavathi View Post
    Hi all,

    Pls confirm my codes...

    47556
    47525
    47505
    74363
    75984
    74305

    576.2

    I am not sure to code 47556 and 47525 together. Please clarify

    BILIARY STENT PLACEMENT
    CLINICAL HISTORY:
    THE PATIENT WOMAN WITH NEWLY DIAGNOSED PANCREATIC HEAD
    ADENOCARCINOMA CAUSING BILIARY DUCT OBSTRUCTION. THE PATIENT PREVIOUSLY UNDERWENT PLACEMENT OF AN INTERNAL AND EXTERNAL BILIARY DRAINAGE CATHETER ON JULY 28, 2009.

    [I]PLACEMENT OF AN INTERNAL COMMON BILE DUCT STENT FOR INTERNALIZATION IS INDICATED WITH MODERATE SEDATION.[/I]PROCEDURE:

    THE PATIENT PROVIDED SIGNED INFORMED CONSENT PRIOR TO THE PROCEDURE. THE
    PATIENT WAS BROUGHT TO THE ANGIOGRAPHY SUITE, AND HER RIGHT UPPER QUADRANT
    WAS PREPPED AND DRAPED IN THE USUAL STERILE FASHION. SPOT FILM DEMONSTRATED
    THE INTERNAL-EXTERNAL DRAIN IN PLACE. A BENTSON WIRE WAS ADVANCED THROUGH
    THE CATHETER INTO THE JEJUNLJN AND THE INTERNAL-EXTERNAL DRAIN WAS REMOVED.
    A VER CATHETER WAS ADVANCED OVER THE WIRE INTO THE DUODENUM. THE BENTSON
    WIRE WAS EXCHANGED FOR AN AMPLATZ STIFF WIRE, ADVANCED INTO THE JEIYUNUM.
    THE CATHETER WAS REMOVED. A 10-FRENCH SHEATH WAS ADVANCED TO APPROXIMATELY
    THE AMPULLA. MULTIPLE INJECTIONS OF CONTRAST WERE PERFORMED TO ELUCIDATE
    THE BILIARY OBSTRUCTION LEVEL AND LENGTH FOR STENT SELECTION. A SMART STENT
    10 MM X 8 CM STENT CHOSEN AND WAS ADVANCED OVER THE WIRE INTO THE COMMON
    DUCT. THE STENT WAS DEPLOYED IN APPROPRIATE POSITION. A REPEAT
    CHOLANGIOGRAN WAS PERFORMED. WITH THE WIRE IN PLACE, A NEW INTERNAL-
    EXTERNAL DRAIN WAS ADVANCED AND POSITIONED APPROPRIATELY WITH THE DISTAL
    COILED TIP IN THE DUODENUM. THE TUBE WAS CAPPED. THE TUBE WAS SUTURED IN
    PLACE.
    DISCUSSION:
    1. INITIAL CHOLANGIOGRAM DEMONSTRATES A LONG-SEGMENT SMOOTH STENOSIS OF
    THE COMMON BILE DUCT.
    2. POST-STENTING CHOLANGIOGRAM DEMONSTRATES EXCELLENT CHOLANGIOGRAPHIC
    RESULT WITH NO PERSISTENT WASTING. NOT MENTIONED ABOVE WAS DILATION OF
    THE STENT WITH 10 MM BALLOON.
    IMPRESSION:
    TECHNICALLY SUCCESSFUL DEPLOYMENT OP A 10 MM X 8 CM SMART STENT WITHIN A
    STENOTIC REGION OF THE PATIENT'S COMMON BILE DUCT. A NEW INTERNAL-EXTERNAL
    DRAIN WAS PLACED AT THE CONCLUSION OF THE PROCEDURE.
    Here goes:
    47556/74363
    47525/75984
    these can be coded together.

    I would not code 47505/74305 because the injections were after the previous biliary catheter had been removed and (the injections) were made to help determine the length of the stent, not as a diagnostic exam to determine the course of action IMO.

    HTH
    Danny L. Peoples
    CIRCC,CPC

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