In interventional radiology coding, there are some complex non-vascular procedures. These procedures are mostly diagnostic procedures. Diagnostic procedures are done to find abnormalities related to particular organ. Abnormalities like obstruction, calculi or accumulation of fluid are common to find through diagnostic procedures. If we take medical coding as a career, learning these procedures will help in building your coding skills. So, here we will discuss one the diagnostic procedure named as percutaneous tranhepatic cholangiogram.
How percutaneous transhepatic cholangiogram is performed?
First the patient is anesthetized with a local anesthetic agent. Then under sterile condition a needle is inserted in the intrahepatic biliary duct. Since, the procedure is performed through hepatic biliary duct it is called as percutaneous transhepatic cholangiogram. When the needle is inserted, images were taken under fluoroscopic guidance. This will help in the checking the final position of the needle. Once, the needle reached at final point, a guide wire is placed along the needle. The needle is removed and a catheter is placed along the guidewire. Now, the contrast is injected through the catheter to perform cholangiogram.
Percutaneous transhepatic cholangiogram cpt code
The cpt codes are used depending on the documentation in the report. The cpt code for Percutaneous transhepatic cholangiogram is 47500 and 47505. 47500 cpt code is used when the cholangiogram is done through the newly placed catheter. 47505 cpt code is used when the cholangiogram is done through the already placed catheter. So, while coding any of these codes please check whether the catheter is new or already present. Also, there should be some diagnostic finding given after performing cholangiogram. Since, we are coding a diagnostic exam, diagnostic finding are must to code that cpt.
While placing T-Tube, always cholangiogram is performed to check the proper placement of T-tube. T-tube placement cpt code 47510 is coded primary but most of us also code 47500 or 47505. So, in such it is very important to check why the cholangiogram is performed. There are two condition to perform cholangiogram
- To check the proper placement of T-tube.
- To find the diagnostic finding after placement of T-tube.
So, if the cholangiogram is performed just to check the final position of T-tube, the cholangiogram code is included with the T-tube placement cpt code 47510. But, if there are diagnostic finding mention along with T-tube placement then cpt code 47500 should also be coded with 59 modifier.
Now, I hope you can have clear idea when to code the percutaneous transhepatic cholangiogram while placing T-tube. Also, how to use 59 modifier while coding these procedures.