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What code do I use for Internalization of the left biliary catheter to internal/external biliary drainage catheter???
This is a copy of the report...
So far these are my codes...
47505
47505
47525
74305
74305
75984
????
????
99144
Exam:
1. Right cholangiogram through existing catheter
2. Left cholangiogram through existing catheter
2. Exchange of right-sided internal/external biliary catheter.
3. Internalization of the left biliary catheter to internal/external
biliary drainage catheter.
Catheters: Two 8 French internal/external biliary drainage catheters.
MEDICATION: Local and conscious sedation. 4.5 grams Zosyn IV also
administered.
TECHNIQUE: The risks, benefits and procedure itself were explained to
the patient and informed written consent was obtained. The patient was
placed on the table in the supine position. Bilateral existing tubes and
overlying skin was cleaned and draped in sterile fashion. First the
right-sided catheter was injected with contrast. A superstiff Amplatz
wire was then advanced to the catheter into the small bowel. Catheter
was removed and wire secured. The left biliary drainage catheter was
then injected, unlocked, and a superstiff Amplatz wire advanced.
Catheter removed and 8 French vascular sheath was placed. Using
combination of a stiff angled Glidewire and a Kumpe catheter, the
Glidewire was advanced through the area of tight stenosis and into the
small bowel. The Kumpe catheter was then advanced and a wire exchanged
for a superstiff Amplatz wire. The Kumpe catheter and sheath were then
removed. Prior to removal, extension in the small bowel was confirmed
with injection of contrast through the Kumpe catheter. The kidney sheath
and the catheter were removed and wire secured. 8 French
internal/external biliary drainage catheter was then advanced over the
right wire into the duodenum. Secondly the left 8 French
internal/external biliary catheter was advanced. Both pigtails were
formed and proximal side holes positioned appropriately. Both catheters
were sutured in place using 2-0 silk. Adhesive device used to secure
catheters. Patient tolerated the procedure well without post procedural
complication.
FINDINGS:
1. Initial cholangiogram demonstrated nondilated right biliary system.
Contrast extended into the small bowel primarily about the catheter.
Again, tight narrowing is seen involving the distal right common bile
duct.
2. Left biliary cholangiogram. The left biliary ductal system has
markedly decreased in dilatation from prior examination with only mild
residual dilatation. Contrast is seen to extend laterally filling a
right hepatic duct as well as extending into the common bile duct. There
is tight stenosis at this involving the distal left hepatic duct,
however, contrast does extend through this region.
3. Multiple images demonstrating positioning of wires through both
systems into the duodenum with biliary catheters appropriately
positioned.
4. Contrast injection for both wire placement and final positioning of
the pigtail catheter was documented.
IMPRESSION:
1. Tight stenosis involving the distal right and distal left hepatic
duct consistent with patient's known Klatskin's tumor.
2. Bilateral decompressed biliary systems.
3. Successful exchange of the right-sided internal/external biliary
drainage catheter.
4. Successful internalization of the left biliary drainage catheter.
PLAN:
1. Patient will be drained by gravity bag for 24 hours and then capped
for internal drainage.
2. Recommend flushing biliary drainage catheters b.i.d. with normal
saline 10 mL, do not aspirate.
3. Patient will return for biliary drain check change every 6 weeks.
Discussion of internal stents should be made prior to next exchange so
this can be performed at that time.
This is a copy of the report...
So far these are my codes...
47505
47505
47525
74305
74305
75984
????
????
99144
Exam:
1. Right cholangiogram through existing catheter
2. Left cholangiogram through existing catheter
2. Exchange of right-sided internal/external biliary catheter.
3. Internalization of the left biliary catheter to internal/external
biliary drainage catheter.
Catheters: Two 8 French internal/external biliary drainage catheters.
MEDICATION: Local and conscious sedation. 4.5 grams Zosyn IV also
administered.
TECHNIQUE: The risks, benefits and procedure itself were explained to
the patient and informed written consent was obtained. The patient was
placed on the table in the supine position. Bilateral existing tubes and
overlying skin was cleaned and draped in sterile fashion. First the
right-sided catheter was injected with contrast. A superstiff Amplatz
wire was then advanced to the catheter into the small bowel. Catheter
was removed and wire secured. The left biliary drainage catheter was
then injected, unlocked, and a superstiff Amplatz wire advanced.
Catheter removed and 8 French vascular sheath was placed. Using
combination of a stiff angled Glidewire and a Kumpe catheter, the
Glidewire was advanced through the area of tight stenosis and into the
small bowel. The Kumpe catheter was then advanced and a wire exchanged
for a superstiff Amplatz wire. The Kumpe catheter and sheath were then
removed. Prior to removal, extension in the small bowel was confirmed
with injection of contrast through the Kumpe catheter. The kidney sheath
and the catheter were removed and wire secured. 8 French
internal/external biliary drainage catheter was then advanced over the
right wire into the duodenum. Secondly the left 8 French
internal/external biliary catheter was advanced. Both pigtails were
formed and proximal side holes positioned appropriately. Both catheters
were sutured in place using 2-0 silk. Adhesive device used to secure
catheters. Patient tolerated the procedure well without post procedural
complication.
FINDINGS:
1. Initial cholangiogram demonstrated nondilated right biliary system.
Contrast extended into the small bowel primarily about the catheter.
Again, tight narrowing is seen involving the distal right common bile
duct.
2. Left biliary cholangiogram. The left biliary ductal system has
markedly decreased in dilatation from prior examination with only mild
residual dilatation. Contrast is seen to extend laterally filling a
right hepatic duct as well as extending into the common bile duct. There
is tight stenosis at this involving the distal left hepatic duct,
however, contrast does extend through this region.
3. Multiple images demonstrating positioning of wires through both
systems into the duodenum with biliary catheters appropriately
positioned.
4. Contrast injection for both wire placement and final positioning of
the pigtail catheter was documented.
IMPRESSION:
1. Tight stenosis involving the distal right and distal left hepatic
duct consistent with patient's known Klatskin's tumor.
2. Bilateral decompressed biliary systems.
3. Successful exchange of the right-sided internal/external biliary
drainage catheter.
4. Successful internalization of the left biliary drainage catheter.
PLAN:
1. Patient will be drained by gravity bag for 24 hours and then capped
for internal drainage.
2. Recommend flushing biliary drainage catheters b.i.d. with normal
saline 10 mL, do not aspirate.
3. Patient will return for biliary drain check change every 6 weeks.
Discussion of internal stents should be made prior to next exchange so
this can be performed at that time.
Last edited:
