# need help/ 2nd time posting!



## chembree (Feb 1, 2010)

I posted this in an earlier thred but did not receive any replies so I am reposting it hoping someone may be able to help...

This report was performed by Dr. YYYYY (which is one of our IR doctors and Dr.XXXXX who is not in our practice and I can not see his reports) 

ERCP -: 

INDICATION: Suspected biliary obstruction and history of cholecystectomy
with indwelling T-tube.

Through existing T-tube under sterile conditions, contrast was
administered after written informed consent was obtained. T-tube
cholangiographic images showed fairly rapid spill of contrast from the
nondilated common hepatic and common bile duct on into the duodenum
through the ampulla with reflux of contrast into the pancreatic duct
occurring.

Next, a Glidewire was utilized placed through existing T-tube and this
Glidewire was used to traverse on into the small bowel through the
ampulla. Next, Kumpe catheter was inserted over the Glidewire and there
was exchange for a 450.0 cm guidewire. ET tube been removed, the
guidewire was secured to the patient's skin and the patient is placed in
the upright position for ERCP subsequently performed by Dr. XXXX. ERCP
images obtained show no evidence of filling defect to suggest a retained
stone in the common bile duct. At the conclusion of ERCP, a 10-French
5.0 cm internal plastic biliary stent was placed to allow drainage. A
sphincterotomy was also performed. 

Please see Dr. XXXX's ERCP report.

IMPRESSION: Combined procedure with Dr. XXXX. The T-tube cholangiogram
was performed showing no definite stone or obstruction as suggested by
previous cholangiograms. It is therefore presumed that the degree of
obstruction seen previously was actually likely edema related.

Wire passage was performed to assist Dr. XXXX for access with ERCP.

Internal biliary stent was placed for preventive purposes.


This is what I have so far...
47505
74305

74330-52

47801
75982

I have not checked th CCI edits yet. I am not sure how I should code the catheter that was placed. 



Thanks for your help in advance!


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## HNISHA (Feb 1, 2010)

*biliary stent*

I would prefer the following codes:

47505 (T tube cholangiogram)
74305-26 (S&I for 47505)
74328-26 (ERCP)
47556 (Biliary structure dilatation with stent Via T-tube)
74363-26 (S&I for 47556)

The CPT 47801 may not be used since, it is a open procedure. 

Hope this helps !

Thanks,
Abdul Saleem CPC


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