# alligator biopsy-cytologic brushings biopsy??



## chembree (Jul 13, 2009)

How would you code the biopsies on this procedure? 

 PERCUTANEOUS BILIARY DRAIN CATHETER:

   INDICATION: Intrahepatic ductal dilatation, hyperbilirubinemia,
   suspected neoplastic stricture at confluence of left and right
   intrahepatic ducts.

   PROCEDURE/FINDINGS:  After informed consent was obtained, under sterile
   conditions and administration local anesthetic, a 21-gauge needle was
   used to puncture the right dilated biliary radical. An .018 guidewire
   was inserted. The .018 guidewire did traverse the tight stenosis related
   to stricture. Next, a transitional catheter set was used. An .035
   guidewire was utilized. An 8-French sheath was placed through which
   cytologic brushings were made across a stricture in addition to an
   alligator biopsy device being used to obtain tissue, placed in formalin.
   Over a guidewire, an 8-French pigtail internal/external biliary drain
   was placed and connected to gravity drainage bag and secured to the
   patient's skin.

   The patient was provided Versed and fentanyl given intravenously for
   adequate conscious sedation during the procedure.

   IMPRESSION: 

   1. Internal/external biliary drain placement following biliary stricture
   cytologic brushings and forceps biopsy of stricture.

   2. The patient may need a left-sided drain for further decompression if
   bilirubin does not improve significantly with this internal/external
   drain.


----------



## Jim Pawloski (Jul 13, 2009)

*Biopsy code*



c422rad said:


> How would you code the biopsies on this procedure?
> 
> PERCUTANEOUS BILIARY DRAIN CATHETER:
> 
> ...



Use 47552 - Choleangioscopy, perc., w/ or w/o brushing or washing
and 47553 - Choleangioscopy, perc. with biopsy


----------



## elamathi (Jul 14, 2009)

My codes are,

47511
47552
75982
99144

You may need to clarifiy whether to code an Unlisted procedure for aligator biopsy of the stricture.

Elamathi


----------



## chembree (Jul 14, 2009)

I seen the 47552 and 47553 but did not think I could use them because they includes endoscopy?


----------



## Jim Pawloski (Jul 14, 2009)

c422rad said:


> I seen the 47552 and 47553 but did not think I could use them because they includes endoscopy?



According to SIR, Cpt editorial panel and CMS states that "endoscopy codes" are considered accurate for discribing codes 47552 - 47556, done either endoscopically or percutaneously.


----------



## chembree (Jul 15, 2009)

That is very helpful! Can you send me the link to this information so that I can show this to the other coders in the office! 


Thanks so much!
Christy Hembree,CPC


----------



## Jim Pawloski (Jul 17, 2009)

c422rad said:


> That is very helpful! Can you send me the link to this information so that I can show this to the other coders in the office!
> 
> 
> Thanks so much!
> Christy Hembree,CPC



I found the info in the Society of Interventional Radiology's Coding Users' Guide on Pgs. 126-7 on the use of "scopy" codes.


----------

