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Wiki Biliary drainage catheter removal and replacement with 2 drains

aswaffer

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We have a patient with complex fluid collections extending along the dome of the Liver and along the medial side of the Liver into the gallbladder fossa. Contrast was injected via the existing drain demonstrating communication with the medial collection although not clearing. Decision was made to replace with 2 drains. A Rosen wire was placed and the drain was removed. Subsequently, two 10.2 French biliary drains were placed; one directed cranially with loop formed in the subdiaphragmatic space, the caudal drain was placed with the tip in the Gallbladder fossa. How would this be coded since both were placed via same access: Would one exchange (49423) and one new placement (49406) be appropriate in this case? Thank You!
 
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