# Catheter Change and Duct Brushing



## drobinson1 (Sep 3, 2009)

Can someone please give me some CPT assitance. I believe I should code this report with 47525, 75984,47999, and 99144 but I am not sure.

The patient was placed on table in supine position. 
Monitored conscious sedation was administered for 30 minutes. 
The indwelling right internal/external biliary drainage
catheter and surrounding skin were prepped and draped in sterile fashion.
Local anesthesia was infused at the entry site. Small amount of contrast
was introduced via the catheter to opacify the biliary system. The
indwelling 8 French internal/external biliary drainage catheter was
exchanged out over an Amplatz guidewire. A 6 French Balkan sheath was
then advanced across the occluded segment of the distal common bile duct
at the enteric anastomosis. Cytology brush was advanced to the Balkan
sheath and positioned across the occluded segment and brushings obtained.
To cytology brushes were utilized in series. Both were processed inside
light for cytopathology. Next, the Balkan sheath was exchanged out over
the Amplatz wire for a new 8 French internal/external biliary drain. The
distal loop was formed within the jejunum in the proximal side holes
positioned along the common hepatic duct and extending into the central
aspect of the right intrahepatic bile duct. Catheter was flushed and
returned to external gravity drainage. The catheter was secured at the
skin with suture of 2-0 Ethilon an sterile dressing applied. Patient
tolerated the procedure well. No complication was encountered.


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## chembree (Sep 3, 2009)

https://www.aapc.com/memberarea/forums/showthread.php?t=20197


As far as coding the cytologic brushings I posted a similar question to this a while back and was told…

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*.

(Society of Interventional Radiology's Coding Users' Guide on Pgs. 126-7 on the use of "scopy")


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## MLS2 (Sep 3, 2009)

Per the Interventional Radiology Coding Users' Guide for 2009  codes 47552-47556 are to be considered the accurate codes for describing these services whether performed percutaneously or by endoscopic approach.

I'm thinking 47552 for this one...along with 75984/47525

Biliary endoscopy, percutaneous via T-tube or other tract; diagnostic, with or without collection of specimen(s) by brushing and/or washing (separate procedure)


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## drobinson1 (Sep 3, 2009)

Thank you.


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