# biliary catheter to internal/external biliary catheter



## chembree (Aug 4, 2009)

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.


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## Jim Pawloski (Aug 4, 2009)

c422rad said:


> 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...
> 
> ...



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


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## chembree (Aug 7, 2009)

Thank you for your help!


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## drsnpatil (Aug 7, 2009)

Thanks both of you Christy and Jim.


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## azwilson2 (Dec 4, 2009)

*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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