Wiki Biliary stent placement

[Anug123]

Hi all,

Pls confirm my codes...

47556
47525
47505
74363
75984
74305

576.2

I am not sure to code 47556 and 47525 together. Please clarify

BILIARY STENT PLACEMENT
CLINICAL HISTORY:
THE PATIENT WOMAN WITH NEWLY DIAGNOSED PANCREATIC HEAD
ADENOCARCINOMA CAUSING BILIARY DUCT OBSTRUCTION. THE PATIENT PREVIOUSLY
UNDERWENT PLACEMENT OF AN INTERNAL AND EXTERNAL BILIARY DRAINAGE CATHETER
ON JULY 28, 2009. PLACEMENT OF AN INTERNAL COMMON BILE DUCT STENT FOR
INTERNALIZATION IS INDICATED WITH MODERATE SEDATION.
PROCEDURE:
THE PATIENT PROVIDED SIGNED INFORMED CONSENT PRIOR TO THE PROCEDURE. THE
PATIENT WAS BROUGHT TO THE ANGIOGRAPHY SUITE, AND HER RIGHT UPPER QUADRANT
WAS PREPPED AND DRAPED IN THE USUAL STERILE FASHION. SPOT FILM DEMONSTRATED
THE INTERNAL-EXTERNAL DRAIN IN PLACE. A BENTSON WIRE WAS ADVANCED THROUGH
THE CATHETER INTO THE JEJUNLJN AND THE INTERNAL-EXTERNAL DRAIN WAS REMOVED.
A VER CATHETER WAS ADVANCED OVER THE WIRE INTO THE DUODENUM. THE BENTSON
WIRE WAS EXCHANGED FOR AN AMPLATZ STIFF WIRE, ADVANCED INTO THE JEIYUNUM.
THE CATHETER WAS REMOVED. A 10-FRENCH SHEATH WAS ADVANCED TO APPROXIMATELY
THE AMPULLA. MULTIPLE INJECTIONS OF CONTRAST WERE PERFORMED TO ELUCIDATE
THE BILIARY OBSTRUCTION LEVEL AND LENGTH FOR STENT SELECTION. A SMART STENT
10 MM X 8 CM STENT CHOSEN AND WAS ADVANCED OVER THE WIRE INTO THE COMMON
DUCT. THE STENT WAS DEPLOYED IN APPROPRIATE POSITION. A REPEAT
CHOLANGIOGRAN WAS PERFORMED. WITH THE WIRE IN PLACE, A NEW INTERNAL-
EXTERNAL DRAIN WAS ADVANCED AND POSITIONED APPROPRIATELY WITH THE DISTAL
COILED TIP IN THE DUODENUM. THE TUBE WAS CAPPED. THE TUBE WAS SUTURED IN
PLACE.
DISCUSSION:
1. INITIAL CHOLANGIOGRAM DEMONSTRATES A LONG-SEGMENT SMOOTH STENOSIS OF
THE COMMON BILE DUCT.
2. POST-STENTING CHOLANGIOGRAM DEMONSTRATES EXCELLENT CHOLANGIOGRAPHIC
RESULT WITH NO PERSISTENT WASTING. NOT MENTIONED ABOVE WAS DILATION OF
THE STENT WITH 10 MM BALLOON.
IMPRESSION:
TECHNICALLY SUCCESSFUL DEPLOYMENT OP A 10 MM X 8 CM SMART STENT WITHIN A
STENOTIC REGION OF THE PATIENT’S COMMON BILE DUCT. A NEW INTERNAL-EXTERNAL
DRAIN WAS PLACED AT THE CONCLUSION OF THE PROCEDURE.

 

[dpeoples]

Hi all,

Pls confirm my codes...

47556
47525
47505
74363
75984
74305

576.2

I am not sure to code 47556 and 47525 together. Please clarify

BILIARY STENT PLACEMENT
CLINICAL HISTORY:
THE PATIENT WOMAN WITH NEWLY DIAGNOSED PANCREATIC HEAD
ADENOCARCINOMA CAUSING BILIARY DUCT OBSTRUCTION. THE PATIENT PREVIOUSLY UNDERWENT PLACEMENT OF AN INTERNAL AND EXTERNAL BILIARY DRAINAGE CATHETER ON JULY 28, 2009.

[I]PLACEMENT OF AN INTERNAL COMMON BILE DUCT STENT FOR INTERNALIZATION IS INDICATED WITH MODERATE SEDATION.[/I]PROCEDURE:

THE PATIENT PROVIDED SIGNED INFORMED CONSENT PRIOR TO THE PROCEDURE. THE
PATIENT WAS BROUGHT TO THE ANGIOGRAPHY SUITE, AND HER RIGHT UPPER QUADRANT
WAS PREPPED AND DRAPED IN THE USUAL STERILE FASHION. SPOT FILM DEMONSTRATED
THE INTERNAL-EXTERNAL DRAIN IN PLACE. A BENTSON WIRE WAS ADVANCED THROUGH
THE CATHETER INTO THE JEJUNLJN AND THE INTERNAL-EXTERNAL DRAIN WAS REMOVED.
A VER CATHETER WAS ADVANCED OVER THE WIRE INTO THE DUODENUM. THE BENTSON
WIRE WAS EXCHANGED FOR AN AMPLATZ STIFF WIRE, ADVANCED INTO THE JEIYUNUM.
THE CATHETER WAS REMOVED. A 10-FRENCH SHEATH WAS ADVANCED TO APPROXIMATELY
THE AMPULLA. MULTIPLE INJECTIONS OF CONTRAST WERE PERFORMED TO ELUCIDATE
THE BILIARY OBSTRUCTION LEVEL AND LENGTH FOR STENT SELECTION. A SMART STENT
10 MM X 8 CM STENT CHOSEN AND WAS ADVANCED OVER THE WIRE INTO THE COMMON
DUCT. THE STENT WAS DEPLOYED IN APPROPRIATE POSITION. A REPEAT
CHOLANGIOGRAN WAS PERFORMED. WITH THE WIRE IN PLACE, A NEW INTERNAL-
EXTERNAL DRAIN WAS ADVANCED AND POSITIONED APPROPRIATELY WITH THE DISTAL
COILED TIP IN THE DUODENUM. THE TUBE WAS CAPPED. THE TUBE WAS SUTURED IN
PLACE.
DISCUSSION:
1. INITIAL CHOLANGIOGRAM DEMONSTRATES A LONG-SEGMENT SMOOTH STENOSIS OF
THE COMMON BILE DUCT.
2. POST-STENTING CHOLANGIOGRAM DEMONSTRATES EXCELLENT CHOLANGIOGRAPHIC
RESULT WITH NO PERSISTENT WASTING. NOT MENTIONED ABOVE WAS DILATION OF
THE STENT WITH 10 MM BALLOON.
IMPRESSION:
TECHNICALLY SUCCESSFUL DEPLOYMENT OP A 10 MM X 8 CM SMART STENT WITHIN A
STENOTIC REGION OF THE PATIENT'S COMMON BILE DUCT. A NEW INTERNAL-EXTERNAL
DRAIN WAS PLACED AT THE CONCLUSION OF THE PROCEDURE.

Here goes:
47556/74363
47525/75984
these can be coded together.

I would not code 47505/74305 because the injections were after the previous biliary catheter had been removed and (the injections) were made to help determine the length of the stent, not as a diagnostic exam to determine the course of action IMO.

HTH