# Transhepatic Cholangiogram



## Anug123 (Aug 26, 2009)

Hi all,

Pls confirm my codes..
*47525
47500-59
47511
75982
74320
75984
99144

576.2  do we need to add 47505,74305 but there is no interpretation.  biliary drain was placed in the duodenum thru other access and replacement thru surgical site.  I havn't billed 47525,47511 together so far.

*
HISTORY:
PATIENT WITH HISTORY OF STATUS POST CHOLECYSTECTOMY WHO HAS AN
INTERNAL/EXTERNAL BILIARY DRAIN AND IN A PRIOR CHOLANGIOGRAM WAS NOTED
THAT THE RIGHT SIDED BILE DUCTS ARE NOT DRAINING AND NOT CONNECTED ARE
PARTIALLY OCCLUDED BY A SURGICAL CLIP AND NOT CONNECTED TO THE LEFT
BILIARY DUCTS.
THE PATIENT IS SCHEDULED FOR A TRANSHEPATIC CHOLANGIOGRAM AND POSSIBLE PLACEMENT OF AN INTERNAL/EXTERNAL BILIARY DRAIN.
PROCEDURE:
1. INTRAVENOUS CONSCIOUS SEDATION.
2. CHOLANGIOGRAM VIA EXISTING CATHETER.
3. TRANSHEPATIC CHOLANGIOGRAM TO PUNCTURE RIGHT SIDED DUCTS.
4. ADVANCEMENT THROUGH THE ORIGIN OF A DUCT INTO THE SURGICAL TRACT.
5. MANEUVERING OF CATHETER AND LT-GLIDE WIRE DOWN TO THE DUODENUM.
6. PLACEMENT OF INTERNAL/EXTERNAL DRAIN.
7. PLACEMENT OF A DRAINAGE CATHETER INTO THE PREVIOUS SURGICAL DRAINAGE TACT.
PROCEDURE IN DETAIL:
THE RISKS AND BENEFITS OF THIS PROCEDURE WERE DISCUSSED WITH THE
PATIENT. SIGNED CONSENT WAS OBTAINED. THE PATIENT WAS TRANSFERRED
TO THE ANGIOGRAPHIC SUITE AND PLACED IN THE SUPINE POSITION.
CHOLANGIOGRAM VIA THE EXISTING INTERNAL/EXTERNAL TUBE WAS PERFORMED AND THE RIGHT DUCTS WERE VISUALIZED.

A TRANSHEPATIC CHOLANGIOGRAM WAS PERFORMED UNDER FLUOROSCOPIC GUIDANCE TO PUNCTURE THE RIGHT DUCTS.
A KUMPE CATHETER AND LT-GLIDEWIRE WERE USED TO ENTER TO CROSS THE
STRICTURE AT THE ORIGIN OF THE RIGHT DUCT AND USING A SOFT OMNI
CATHETER ALONG THE SURGICAL TRACT, THE CATHETER AND THE LT-GLIDEWIRE
WERE MANEUVERED DOWN INTO THE DUODENUM. AN INTERNAL/EXTERNAL BILIARY
DRAIN WAS THEN PLACED AND SECURED IN PLACE.
THE PREVIOUSLY REMOVED INTERNAL/EXTERNAL DRAIN THROUGH THE SURGICAL
TRACT WAS REPLACED BY A 10-FRENCH APDL SINCE IT WAS NOTED THAT
ACCUMULATION OF CONTRAST WAS SEEN AT THE LEVEL OF THE ORIGIN OF THE
RIGHT DUCT.
THE PATIENT TOLERATED THE PROCEDURE WELL.


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## lavanyamohan (Aug 27, 2009)

Hello,
Code 43260, may be needed if this is retrograde.
47525, 47511 are fine, too.
Can use 77003 for fluoroscopy, if required.
74320, 75984 can be considered, too.

LMohan


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## Kimberfly (Aug 27, 2009)

I agree with your codes but you need some additional modifiers.

74320 is bundled into 75982 but since this is a separate diagnostic study, then 59 is ok.
75982 also needs a 59 because it is mutually exclusive to 75984 but since this was a different side, you're ok to add the 59.

99144 is not adequately documented. You already know that they didn't give the length of time but they also must document a quick statement that the patient was monitored by the nurse or other trained observer.


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## Anug123 (Aug 30, 2009)

Thank you Kim & LM


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