Radiology Coding Alert

In the article CPT 2002 Introduction Contains Major Change, on page 4 of the January 2002 Radiology Coding Alert , we erroneously provided an example of a case in which an unlisted procedure code might be useful.

"A percutaneous cholangiogram with insertion of ring biliary drainage catheter was performed on July 25. On Aug. 2 the following report was dictated:

"Removal of ring biliary drainage catheter and insertion of two gianturco coils. The ring biliary drainage catheter was still in place in the right upper quadrant of the abdomen. The guide wire was placed through the catheter and the catheter withdrawn. A non-side hole C2 catheter was then placed such that the distal tip was in the tract within the liver where the catheter had been placed. Two 3-mm-x-4-cm-long coils were placed in the intra-hepatic tract in hopes of promoting clotting so that the bile would not drain into the peritoneal cavity. The patient tolerated the procedure well."

This example, in fact, described several biliary procedures that took place on two separate dates of service. Upon review, it is clear that only one of the services (and a rarely performed service at that) would be appropriate for the use of an unlisted procedure code. The remainder of the services are appropriately described by existing and specific CPT Codes .

On the original date of service, two surgical procedures were provided together with radiology supervision and interpretation services. First, a percutaneous transhepatic cholangiogram was provided. This is coded as 47500 (Injection procedure for percutaneous transhepatic cholangiography) with 74320 (Cholangiography, percutaneous, transhepatic, radiological supervision and interpretation). An internal and external biliary drainage catheter is placed and is reported as 47511 (Introduction of percutaneous transhepatic stent for internal and external biliary drainage) together with 75982 (Percutaneous placement of drainage catheter for combined internal and external biliary drainage or of a drainage stent for internal biliary drainage in patients with an inoperable mechanical biliary obstruction, radiological supervision and interpretation). If an external drainage catheter had been placed, it would have been reported with 47510 (Introduction of percutaneous transhepatic catheter for biliary drainage) and 75980 (Percutaneous transhepatic biliary drainage with contrast monitoring, radiological supervision and interpretation) in place of 47511 and 75982.

On the second date of service, the catheter was removed and the tract was embolized by the use of two coils. This constellation of services within this time frame is rare, as is the need to place coils in the tract when removing such drainage catheters. However, should such a procedure need to be performed, there is no current code to report the embolization of the tract. Therefore, report the service with 47999 (Unlisted procedure, biliary tract) in conjunction with 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) for the fluoroscopic guidance and monitoring for the placement of the coils. Because the second procedure took place within the global period for the initial catheter placement (90 days), it would be necessary to use the appropriate modifier with 47999 with either -58 (Staged or related procedure or service by the same physician during the postoperative period) or -78 (Return to the operating room for a related procedure during the postoperative period) as dictated by the details of this unusual case.