# 2 biliary drainage catheters



## Shirleybala (Apr 1, 2009)

Hi all:

Can anybody confirm my codes.Is there 2 biliary drainage catheters.
47505	
47505	59
47525	
47525	59
74305	26
74305	2659
75984	26
75984	2659

Following informed consent, the right flank, right lower chest and indwelling abdominal catheter were
prepped and draped in sterile fashion. The approximate position of the metastatic implants along the right
lobe of the liver were marked on the right flank sonographically. Contrast was injected via the indwelling
biliary drainage tube and percutaneous transhepatic cholangiogram was performed.
The biliary catheter was cut and a wire was passed into the bowel. The biliary catheter was then exchanged
for an 8-French bright tip sheath. The bright tip sheath was advanced to the approximate position of the
confluence and contrast was injected demonstrating a right biliary duct. A Berenstein catheter and
Glidewire were used to access the duct and contrast was injected demonstrating this to be the ventrocranial
duct. The Berenstein catheter was then removed and advanced further down common hepatic duct where
catheter and Glidewire techniques were used to cannulate the dorsocaudal duct which was noted to be
severely stenotic at its origin. The dorsocaudal duct was opacified gently via injection through the
Berenstein catheter.
A 22-gauge needle was then advanced from the right flank at the inferior tip of the liver beneath the
approximate position of the hepatic metastatic implants, into a peripheral dorsocaudal duct under
fluoroscopic guidance. A wire was advanced into the biliary system. The inner dilator of an AccuStick set
was then advanced and contrast injected, demonstrating access into the dorsocaudal biliary system. The
catheter could not be manipulated centrally from this point. A 21G needle was advanced from the right
flank using the same skin access into a separate peripheral dorsocaudal duct. A wire was passed into the
main dorsocaudal duct. An AccuStick set was advanced over the wire. A Berenstein catheter and Glidewire
were used to access the common hepatic duct, the wire was then advanced down into the bowel followed by
the Berenstein catheter over the wire. The glide wire was then exchanged for an Amplatz wire which was
advanced well into the small bowel. The Neff set was then exchanged for an 8-French biliary drainage
catheter which was placed with distal tip in the small bowel and its proximal sideholes in the right
dorsocaudal ducts. Contrast injection through the catheter demonstrated good position of the catheter with
opacification of the small bowel and the dorsocaudal ducts.
The Berenstein catheter and Glidewire were again passed through the left sided 8-French bright tip sheath
from the left biliary system into the ventrocranial ducts. Gentle contrast injection demonstrated satisfactory
position within the ventrocranial duct. The Glidewire was exchanged for an Amplatz wire. The Berenstein
catheter was then exchanged for a 6-French locking pigtail catheter which was positioned within the main
ventrocranial duct.
The 8 French bright tip sheath was then exchanged for a new 8-French biliary drainage catheter which was
placed with its distal tip within the small bowel and proximal sideholes within the biliary system. Contrast
injection demonstrated the catheter to be in good position with opacification of the small bowel and left
biliary system.
The catheters were secured to the skin and connected to gravity drainage.
Findings:
Transhepatic cholangiography demonstrates a moderately dilated biliary tree. There is occlusion of the
biliary system at the confluence of the left main biliary duct and right ventrocranial duct as well as the more
central insertion of the dorsocaudal duct. There is good opacification of the bowel and dorsocaudal biliary
system after placement of an 8-French biliary drainage catheter via a right-sided approach. There is
satisfactory position of a 6-French pigtail drainage catheter within the ventrocranial ducts via the left-sided
approach used for prior placement of the left biliary drainage catheter. There is good opacification of the
bowel and the left biliary system after replacement of the 8-French biliary drainage catheter
Impression:
Hilar biliary obstruction secondary to malignancy. Satisfactory placement of left biliary internal/external
drainage catheter, right dorsocaudal internal/external biliary drainage catheter and right ventrocranial
external drainage catheter as above-described. No significant extravasation of contrast was noted during the
procedure.


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## MLS2 (Apr 2, 2009)

sounds like there was a new cath. placement done also


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## elamathi (Apr 2, 2009)

Codes are
47525
75894
47510
75980


Thanks
Elamathi


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## dpeoples (Apr 3, 2009)

Shirleybala said:


> Hi all:
> 
> Can anybody confirm my codes.Is there 2 biliary drainage catheters.
> 47505
> ...



The documentation could be better but here is what I would code:

47505,74305 (cholangiogram through existing catheter/tube. This should only be charged once imo, there is only one biliary system, many ducts but only one system)
47525, 75984 (replacement of existing biliary cath)
47511 LT, 47511 RT, 75982 (x2) for new internal/external biliary cath placements. 

Modifiers such as 58,59,76,78 may also come into play, depending on payer preference and bundling issues. 

You should also consider changing the 47525 to 47530, if one of the new biliary tubes is actually an extention of the previously placed tube. In that scenario you would lose a 47511,75982 combo.

I hope this helps and is not too confusing.


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