Radiology Coding Alert

Question: Which CPT and ICD-9 codes should I use for the following T-tube cholangiogram report?

Clinical indication: Bile duct stone

Findings: Water-soluble contrast was administered through the patient's existing T-tube for performance of a T-tube cholangiogram under fluoroscopic visualization. These images demonstrate good contrast opacification of the intra and extra hepatic biliary tree with free spill of contrast into the duodenum. A few filling defects, felt most compatible with bubbles of air, are seen in the common bile duct and appear to dissipate over time. No filling defect suspicious for residual stone is observed.

Impression: Unremarkable T-tube cholangiogram without evidence of filling defect to suggest retained stone within the biliary tree and with good free spill of contrast material into the duodenum.

South Carolina Subscriber

Answer: Because the radiologist performed this cholangiogram injection procedure through an existing T-tube to search for residual stones, you should report 47505 (Injection procedure for cholangiography through an existing catheter [e.g., percutaneous transhepatic or T-tube]).

For the fluoroscopy, you'll find a note with 47505 that you should report 74305 (Cholangiography and/or pancreatography; through existing catheter, radiological supervision and interpretation).

ICD-9: If the radiologist 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).

In this case, however, the findings were normal. Because the patient has a T-tube in place, he most likely had a recent cholecystectomy and/or common bile duct exploration. If this is the case, the most appropriate code assignment is 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.

To ensure correct postoperative exam coding, the radiologist should indicate the type of surgery in the dictation.

Tip: Some third-party payers may want you to report the reason for the surgery (such as cholecystitis or cholelithiasis) instead of the follow-up code.