# 47511 vs 47556?



## MELJNBBRB (Aug 22, 2013)

Need some help, any suggestions are welcomed. 
I am thinking 47505/74305 for the cholangiogram
47511/75982 OR 47556/74363??
Thanks,
Melissa Bedford,CCS,CPC


INDICATION: Biliary obstruction secondary to pancreatic mass.

PROCEDURE: 
1. Percutaneous transhepatic cholangiogram. 
2. Placement of percutaneous transhepatic biliary stent endoprosthesis. high-grade distal common bile duct stricture.
3. Cholangioplasty of Common Bile Duct stricture.

MEDICATIONS:    1% lidocaine local anesthesia; Versed 1.0 mg IV; fentanyl 125 mcg IV; Cardizem 10 mg IV;
Zosyn 3.375 grams, IV

CONTRAST:  30 cc Omnipaque 300 per PTC access. 

FLUOROSCOPY TIME: 7 minutes.

COMPLICATIONS:    None immediately evident. 

DESCRIPTION:   After the procedure including indication and potential complications had been discussed with the patient and questions answered, written informed consent was obtained.  The patient was then taken to the interventional suite and placed on 
the table in supine position where skin of the right upper abdomen mid axillary line was prepped and draped sterilely.  A time out was performed. 

After achieving 1% lidocaine local anesthesia and anxiolysis, the indwelling percutaneous biliary drain was exchanged over a 0.035 straight Glidewire using fluoroscopic guidance. A 9 French by 20 cm length hemostatic sheath was introduced. A a Kumpe 
catheter was placed over the guidewire and exchange for a 0.035 Amplatz superstiff guidewire. Cholangiography was performed demonstrating a focal high-grade stricture of the distal common bile duct corresponding to known pancreatic mass lesion. Prestent 
placement cholangioplasty was performed using a 7 mm diameter x 100 mm length Blue Max angioplasty balloon catheter. The angioplasty balloon catheter was inflated to 20 atmospheres of pressure. The Viabil (Gore) covered stent endoprosthesis proximal 
perforation, measuring 8mm diameter x 60 mm length deployed across the common bile duct stricture, over the 0.035 Amplatz superstiff guidewire using fluoroscopic guidance. Post stent angioplasty was then performed using 7 mm diameter x 100 mm length Blue
 Max angioplasty balloon catheter, inflated to 20 atmospheres of pressure. Followup cholangiography demonstrates full patency of distal common bile duct with antegrade flow into the duodenum. There is no stasis of contrast within the biliary ducts. There
 is no extravasation of contrast. Images were stored. Following irrigation, there is no significant hemorrhage within the bile drainage. The guidewire and percutaneous sheath were removed. A sterile bandage was applied. The patient tolerated the 
procedure well. There is no immediate competition.

FINDINGS: 
1. Distal common bile duct stricture corresponding to known pancreatic mass.
2. Successful placement of common bile duct stent endoprosthesis with demonstrated full restoration of lumen caliber diameter.

  Impression: IMPRESSION: 
1. Successful placement of common bile duct stent endoprosthesis with demonstrated full restoration of lumen caliber diameter and improved antegrade flow into the duodenum.


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## dpeoples (Aug 23, 2013)

SASSYLDY27 said:


> Need some help, any suggestions are welcomed.
> I am thinking 47505/74305 for the cholangiogram
> 47511/75982 OR 47556/74363??
> Thanks,
> ...




This looks like an internalization of biliary drain. I would code this:
47505/74305
47556/74363

There is no new drain placed so 47511/75892 is not applicable IMO.

HTH


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## MELJNBBRB (Aug 23, 2013)

Thanks Danny for the response, greatly appreciated. At least I know I was on the right path. Have a great day!
Melissa


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