Wiki 47562 or 47563

[hsmith67]

Ongoing debate about if cholangiogram is documented and can be billed.

From the Op note: "At this point, ICG interrogation was then performed and the ICG cholangiogram demonstrating the gallbladder, cystic duct, and the common duct features. Next, dissection was then performed using the robotic hook at the junction of the cystic duct and cystic artery. The critical view was achieved with the cystic duct clearly seen, the cystic artery as well as the liver bed posterior with all fat swept down."

When questioned, the surgeon states: "ICG cholangiogram is part of the robotic cholangiogram using firefly only. No radiographic contrast cholangiogram was performed. It was only ICG given to patient in the preoperative holding area to use Firefly technology to view structures during dissection."

The definition/description for the 47563 states: performs cholangiography by injecting contrast dye into the gallbladder and looks for any abnormalities or stones present.
So, anyone bill these as 47563 or do you bill them as 47562? Any help/guidance is greatly appreciated!

Thanks,
Hunter Smith, CPC

 

[MI_CODER]

Laparoscopic cholecystectomy with fluorescence imaging Coding Clinic for HCPCS - First Quarter 2022 Page: 9-10 Effective Date: March 23, 2022

QUESTION
A patient presented for a robotic assisted laparoscopic cholecystectomy with intraoperative fluorescence imaging using indocyanine green (ICG) dye. Once ports were placed and the robot was docked, the gallbladder was retracted and the cystic duct, cystic artery and infundibulum of the gallbladder were identified. ICG, administered intravenously, was used to visualize the common bile and cystic duct insertions which were identified and clipped. The gallbladder was then dissected off the gallbladder fossa. Is the use of fluorescent imaging with injection of ICG during a laparoscopic cholecystectomy considered intraoperative cholangiogram and reported with CPT code 47563, Laparoscopy, surgical; cholecystectomy with cholangiography? If so, can HCPCS Level II 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), be additionally reported with reported with CPT code 47563?

ANSWER
Fluorescence imaging using ICG dye is a relatively new technology and when utilized with laparoscopic cholecystectomy it is considered intraoperative cholangiography. Therefore, a laparoscopic cholecystectomy with ICG fluorescence imaging is reported with CPT code 47563.

The code descriptor in HCPCS Level II code C9776 indicates this is an add-on code to be reported with the primary procedure. Therefore, code C9776 may be additionally reported to further specify the technology used for the cholangiography as intraoperative near-infrared fluorescence imaging using indocyanine green on the extrahepatic ducts (example, cystic duct, common bile duct, and common hepatic duct).

Intraoperative fluorescent cholangiography during robotic cholecystectomy utilizes indocyanine green imaging to provide real-time visualization of the biliary anatomy. During cholecystectomy, the laser light source illuminates the operative site with infrared light, which causes the ICG to fluoresce. The camera system detects the fluorescing ICG as it passes through the biliary circulation. ICG is administered via peripheral IV.

 

[ramaraju_m84]

Laparoscopic cholecystectomy with fluorescence imaging Coding Clinic for HCPCS - First Quarter 2022 Page: 9-10 Effective Date: March 23, 2022

QUESTION
A patient presented for a robotic assisted laparoscopic cholecystectomy with intraoperative fluorescence imaging using indocyanine green (ICG) dye. Once ports were placed and the robot was docked, the gallbladder was retracted and the cystic duct, cystic artery and infundibulum of the gallbladder were identified. ICG, administered intravenously, was used to visualize the common bile and cystic duct insertions which were identified and clipped. The gallbladder was then dissected off the gallbladder fossa. Is the use of fluorescent imaging with injection of ICG during a laparoscopic cholecystectomy considered intraoperative cholangiogram and reported with CPT code 47563, Laparoscopy, surgical; cholecystectomy with cholangiography? If so, can HCPCS Level II 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), be additionally reported with reported with CPT code 47563?

ANSWER
Fluorescence imaging using ICG dye is a relatively new technology and when utilized with laparoscopic cholecystectomy it is considered intraoperative cholangiography. Therefore, a laparoscopic cholecystectomy with ICG fluorescence imaging is reported with CPT code 47563.

The code descriptor in HCPCS Level II code C9776 indicates this is an add-on code to be reported with the primary procedure. Therefore, code C9776 may be additionally reported to further specify the technology used for the cholangiography as intraoperative near-infrared fluorescence imaging using indocyanine green on the extrahepatic ducts (example, cystic duct, common bile duct, and common hepatic duct).

Intraoperative fluorescent cholangiography during robotic cholecystectomy utilizes indocyanine green imaging to provide real-time visualization of the biliary anatomy. During cholecystectomy, the laser light source illuminates the operative site with infrared light, which causes the ICG to fluoresce. The camera system detects the fluorescing ICG as it passes through the biliary circulation. ICG is administered via peripheral IV.

plz check out this update on this topic. .......Tq

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.



The Central Office on HCPCS apologizes for any confusion the previous advice may have caused.