Radiology Coding Alert

Question: We have encountered a situation in which our physician performed an injection of an existing external/internal biliary drainage catheter and investigated a possible narrowing of the common bile duct. During the procedure, he then removed the existing external/internal drainage catheter. How would we code this case?

Susan Henderson
Radiology Associates of Valdosta, P.C., Valdosta, Ga.

Answer: Assign 47505 (injection procedure for cholangiography through an existing catheter [e.g., percutaneous transhepatic or T-tube]) to describe the procedure in which the physician injected the radiographic medium through an existing external/internal biliary drainage catheter for diagnostic purposes. During the procedure the physician most likely injected a radiographic medium into the gallbladder via an existing tube while visualizing the liver under fluoroscopy. The radiological supervision and interpretation code would be 74305 (cholangiography and/or pancreatography; postoperative, radiological supervision and interpretation).

Removal of the temporary catheter would be considered an incidental component of the primary procedure and, in addition, would fall within the surgical global period for this service. Therefore, it would not be appropriate to code the removal separately.

Source for the two previous Reader Questions is Cindy McMahan, CPC, an independent coding consultant in Albany, Wis.