BILIARY SYSTEM

Percutaneous Transhepatic Cholangiography (PTHC)

PTHC is a diagnostic study that involves placement of a needle into the Bile duct of liver with Injection of contrast and obtaining imaging.

Procedure description:

Appropriately prepped and anesthetized the patient, the physician uses imaging guidance to pass a needle deep into the liver and into the common bile duct and administer a contrast agent then obtain diagnostic images of the bile ducts. After withdraws the needle, applies a sterile dressing at the site of insertion of the needle.

CPT Code : 47500 

         S&I  : 74320

47500-  Injection procedure for percutaneous transhepatic cholangiography.

74320-  Cholangiography, percutaneous, transhepatic, radiological supervision and interpretation. 

Don't use CPT 47500 for existing catheter cholangiography, Instead use CPT 47505. 

If the physician injecting contrast into the previously placed catheter then it would be appropriate to code CPT 47505 -  Injection procedure for cholangiography through an existing catheter with S&I 74305 - Cholangiography and/or pancreatography; through existing catheter, radiological supervision and interpretation

Biliary Tube Cholangiogram:
Its a Tube checking procedure, where contrast is injected through the previously placed biliary catheter

Biliary Drainage 

Biliary drainage is the insertion of a tube into the bile duct. This is most commonly carried out when the bile ducts are blocked.

External biliary drainage catheters can only drain externally and collected in Bag.

Internal and External biliary drainage catheters can drain externally and internally. 

External Biliary Drainage Procedure description: 

Patient is appropriately prepped and anesthetized and the physician uses imaging guidance to place a needle into the biliary tract that carries digestive juices from the liver, gallbladder, and pancreas to the intestines. Then passes a guide wire through the needle and then using the guide wire inserts a catheter into the bile duct. The physician uses the catheter for drainage of fluids and infected material.

CPT - 47510 - Introduction of percutaneous transhepatic catheter for biliary drainage.
S&I - 75980 - Percutaneous transhepatic biliary drainage with contrast monitoring, radiological supervision and interpretation

Internal and External Biliary Drainage Procedure description: 
Internal and External Biliary Drainage procedure is to drain bile both into the external connected bag as well as internally into the intestine.
Patient is appropriately prepped and anesthetized, the physician uses imaging guidance to place a needle into the biliary site. Then passes a guide wire through the needle and then using the guide wire inserts a balloon catheter into the bile duct. Then physician inflates the balloon to expand and clear the obstruction in the bile duct. The physician then removes the balloon catheter and inserts a stent to prevent the recurrence of obstruction in the bile duct. After the procedure, he ensures hemostasis.

CPT - 47511 - Introduction of percutaneous transhepatic stent for internal and external biliary drainage
S&I - 75982 - Percutaneous placement of drainage catheter for combined internal and external biliary drainage in patients with an inoperable mechanical biliary obstruction, radiological supervision and interpretation.

CPT Code 47511 states transhepatic stent for internal and external drainage. The term stent
refers to a catheter that extends from outside the body into the small bowl, Then stent which cannot be seen from outside assign CPT 47556

CPT 47556 - Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) with stent

If a Previously placed External biliary drainage tube is advanced into the duodenum, Use External and Internal Biliary Drainage catheter placement code 47511 with S&I code 75982.

Biliary Catheter Change

If the Biliary catheter is not functioning well or any complication is the indication for catheter change, The catheter is injected with contrast and imaging was obtained then the existing catheter is removed and replaced with a new catheter.

CPT - 47525 - Change of percutaneous biliary drainage catheter 

S&I  -75984 -  Change of percutaneous tube or drainage catheter with contrast monitoring, radiological supervision and interpretation

Biliary Catheter Revision 

 The physician remove and reinsert the same catheter its appropriate to code CPT 47530 - Revision and/or reinsertion of transhepatic tube and S&I code - 75984 (Change of percutaneous tube or drainage catheter with contrast monitoring, radiological supervision and interpretation )