Coding Q&A
By Stephanie L. Dybul, MBA, RT, FSIR, Shekher Maddineni, MD, FSIR
Q How do I code for biliary endoscopy (Spyglass)? A There are a family of codes within the endoscopy section of the American Medical Association’s (AMA’s) Current Procedural Terminology (2022/CPT®)
that are appropriate to use when reporting biliary endoscopy. The most common scenario in IR is to use the device via an existing tract or biliary drainage catheter to directly visualize the biliary system, and subsequently remove biliary stones. In this clinical scenario, it is appropriate to report CPT® code 47554 (Biliary endoscopy, percutaneous via t-tube or other tract with removal of calculus/calculi). Following the stone removal, if the existing biliary drainage catheter is replaced under imaging guidance, it would be appropriate to also report CPT® code 47536 (Exchange of biliary drainage catheter (e.g., external, internal-external, or conversion of internal- external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (e.g., fluoroscopy), and all associated radiological supervision and interpretation).
Additional codes in the biliary endoscopy family are as follows:
•47552—Biliary endoscopy, percutaneous via T-tube or other tract; diagnostic, with collection of specimen(s) by brushing and/or washing, when performed (separate procedure)
•47553—Biliary endoscopy, percutaneous via T-tube or other tract; with biopsy, single or multiple
• 47554—Biliary endoscopy, percutaneous via t-tube or other tract with removal of calculus/calculi)
• 47555—Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) without stent
• 47556—Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) with stent
When combining percutaneous biliary procedures (47531–47544) with endoscopic biliary procedures (47552–47556), documentation should be clear what approach/ technique was used to perform each procedure. If both techniques are used to accomplish a single intervention, one should report the primary guidance technique that was used and only report one code to represent a single procedure. It should also be noted that these code families do not allow for co-surgeon modifier (-62). Only one provider can report a single code for the same session.
Disclaimer: SIR is providing this billing and coding guide for educational and information purposes only. It is not intended to provide legal, medical or any other kind of advice. The guide is meant to be an adjunct to the American Medical Association’s (AMA’s) Current Procedural Terminology (2022/CPT®). It is not comprehensive and does not replace CPT. Our intent is to assist physicians, business managers and coders. Therefore, a precise knowledge of the definitions of the CPT descriptors and the appropriate services associated with each code is mandatory for proper coding of physician service. Please refer to 2022 CPT® for full and complete guidelines.
Every reasonable effort has been made to ensure the accuracy of this guide; but SIR and its employees, agents, officers and directors make no representation, warranty or guarantee that the information provided is error-free or that the use of this guide will prevent differences of opinion or disputes with payers. The publication is provided “as is” without warranty of any kind, either expressed or implied, including, but not limited to, implied warranties or merchantability and fitness for a particular purpose. The company will bear no responsibility or liability for the results or consequences of the use of this manual. The ultimate responsibility for correct use of the Medicare and AMA CPT billing coding system lies with the user. SIR assumes no liability, legal, financial or otherwise for physicians or other entities who utilize the information in this guide in a manner inconsistent with the coverage and payment policies of any payers, including but not limited to Medicare or any Medicare contractors, to which the physician or other entity has submitted claims for the reimbursement of services performed by the physician.
38 IRQ | SPRING 2022
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