LORICPC2003
New
As many know the ongoing issues with the ICG Cholecystectomies. Can anyone tell me if the C9776 is a profee code or if the code is designed for the facility to bill? The way I read is the provider can bill it but most of the C-codes are facility only codes.
Thanks,
Lori
CLARIFICATION
Coding Clinic for HCPCS First Quarter 2022, pages 9-10, advised to report CPT code 47563, Laparoscopy, surgical; cholecystectomy with cholangiography, for a laparoscopic cholecystectomy with intraoperative fluorescence imaging using indocyanine green (ICG) dye. Research indicates that an intraoperative cholangiogram (IOC) requires insertion of a cholangiocatheter into the cystic duct with direct injection of radiographic contrast. However, in the published example, cholangiocatheter insertion into the cystic duct with injection of radiographic contrast was not documented. We believe imaging with ICG dye is not analogous to an IOC. We are asking Coding Clinic for HCPCS to revisit this advice.
ANSWER
In that case, the provider documented, "Indocyanine green dye was administered as well for intraoperative fluorescent cholangiogram." However, after further review, the description of the procedure did not indicate the ICG imaging visualized the bile ducts but rather it was used only to visualize the common bile and cystic duct insertions to aid in dissection. Visualization of structures with ICG to aid with dissection is not analogous to an intraoperative cholangiogram. Therefore, assign CPT code 47562, Laparoscopy, surgical; cholecystectomy, for the laparoscopic cholecystectomy. Continue to report HCPCS Level II add-on code C9776, Intraoperative near-infrared fluorescence imaging of major extra-hepatic bile duct(s) (e.g., cystic duct, common bile duct and common hepatic duct) with intravenous administration of indocyanine green (ICG) (list separately in addition to code for primary procedure), to identify the use of the ICG imaging technology.
Thanks,
Lori
CLARIFICATION
Coding Clinic for HCPCS First Quarter 2022, pages 9-10, advised to report CPT code 47563, Laparoscopy, surgical; cholecystectomy with cholangiography, for a laparoscopic cholecystectomy with intraoperative fluorescence imaging using indocyanine green (ICG) dye. Research indicates that an intraoperative cholangiogram (IOC) requires insertion of a cholangiocatheter into the cystic duct with direct injection of radiographic contrast. However, in the published example, cholangiocatheter insertion into the cystic duct with injection of radiographic contrast was not documented. We believe imaging with ICG dye is not analogous to an IOC. We are asking Coding Clinic for HCPCS to revisit this advice.
ANSWER
In that case, the provider documented, "Indocyanine green dye was administered as well for intraoperative fluorescent cholangiogram." However, after further review, the description of the procedure did not indicate the ICG imaging visualized the bile ducts but rather it was used only to visualize the common bile and cystic duct insertions to aid in dissection. Visualization of structures with ICG to aid with dissection is not analogous to an intraoperative cholangiogram. Therefore, assign CPT code 47562, Laparoscopy, surgical; cholecystectomy, for the laparoscopic cholecystectomy. Continue to report HCPCS Level II add-on code C9776, Intraoperative near-infrared fluorescence imaging of major extra-hepatic bile duct(s) (e.g., cystic duct, common bile duct and common hepatic duct) with intravenous administration of indocyanine green (ICG) (list separately in addition to code for primary procedure), to identify the use of the ICG imaging technology.