Radiology Coding Alert

Question: How should I report a T-tube cholangiogram through the patient's existing T-tube? The physician used fluoroscopic visualization and water-soluble contrast. The clinical indication is "bile duct stone," but the impression states there is no evidence of a retained stone.

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Answer: Because the physician performed this cholangiogram injection procedure through an existing T-tube, you should report 47505 (Injection procedure for cholangiography through an existing catheter [e.g., percutaneous transhepatic or T-tube]). In addition, you should report 74305 (Cholangiography and/or pancreatography; through existing catheter, radiological supervision and interpretation) with 47505, according to CPT notes. Both codes state they apply for services performed through an existing tube.

ICD-9: If the physician documented retained bile duct stones, the appropriate ICD-9 code would be 574.50 (Calculus of bile duct without mention of cholecystitis; without mention of obstruction).

But in this case, there is no evidence of a stone. If the patient had a recent cholecystectomy and/or common bile duct exploration (as evidenced by the T-tube in place), you should code V67.09 (Follow-up examination following other surgery). You can assign V12.79 (Personal history of diseases of digestive system; other) as a secondary diagnosis to indicate the gallbladder disease.

Smart move: The radiologist should indicate in the dictation the type of surgery and the reason for the surgery. Some third-party payers will want to see a code showing the reason for the surgery (such as cholecystitis or cholelithiasis) instead of the follow-up code.