Overcoming Biliary Tract Coding Obstacles

Interventional radiology coding remains some of the most complex to understand and report accurately. With error rates approaching 30% in many areas, there is a lot of opportunity for costly mistakes and omissions. When it comes to the biliary tract, there are a multitude of key components worth knowing for compliant coding. Let’s take a look at the rationale to overcome any obstacles associated with this area.

Bile and Biliary Fundamentals

First and foremost, bile is a fluid that is created in the liver, then flows through bile ducts (tubes/passages) into the gallbladder where it is stored. When a person eats, bile flows from the gallbladder through the bile ducts into the duodenum where it helps with digestion by breaking down fats into fatty acids.

When a bile duct becomes blocked, bile cannot flow into the duodenum causing jaundice, abdominal pain, fever, nausea, vomiting, and other symptoms. Some of the causes of blockages are tumors, scarring, inflammation, and gallstones.

There are open surgical procedures available to evaluate and treat bile-duct blockage. However, percutaneous, minimally invasive procedures performed by interventional radiologists are becoming common. Understand that codes for percutaneous procedures in the biliary system underwent a significant revision for 2016. In addition, Medicare has revised the global periods for most of these procedures to 0 days instead of 90 days. Diagnostic exams are included in most of the therapeutic procedures when performed in the same session, as are imaging and supervision and interpretation.

Coding Breakdown

Cholecystitis is one of the first areas to understand. What is cholecystitis? The condition is classified as inflammation of the gallbladder. A patient with cholecystitis may need to have a drainage catheter placed. When a physician places the drainage tube through the abdominal wall into the gallbladder, code 47490—a complete code—is assigned. Note that this code continues to have a 10-day global period. Injection of contrast to evaluate a previously placed cholecystostomy tudbe should be reported with a cholangiogram through existing access code 47531. Cholecystostomy check and change would be reported with code 47536—exchange of biliary drainage catheter.

Understand that this code would be inclusive of contrast injection through the existing catheter.

47490 Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation

One question that may come up is whether additional imaging should be assigned, or would another guidance code be necessary? For this instance, no additional imaging or guidance code would be assigned. Imaging of the bile ducts after injection of contrast is a cholangiogram. There are several codes to choose from depending on the circumstances.

74300 Cholangiography and/or pancreatography; intraoperative, radiological supervision and interpretation
+74301 Cholangiography and/or pancreatography; additional set intraoperative, radiological supervision and interpretation (List separately in addition to code for primary procedure)

When a radiologist interprets images from a cholangiogram being performed in surgery, he would code 74300-26-52 for the initial set of images. If a subsequent set of images is returned for interpretation, assign code 74301-26-52. Note that Modifier 26 is added to these codes to indicate that only the professional component is being billed. Modifier 52 indicates that a lesser service is performed, in this case interpretation only, not supervision.

47531 Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; existing access
47532 Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; new access (e.g., percutaneous transhepatic cholangiogram)

Understand that the two codes above for stand-alone percutaneous diagnostic cholangiography replace codes 47500, 47505, 74320, and 74305. Both codes are complete codes, including the injection of contrast, imaging, and supervision and interpretation.

So, what is the difference between the two codes and when should each be assigned? Code 47531 is reported when a diagnostic cholangiogram is performed through an existing access such as a T-tube or external biliary drainage catheter.

When there is no existing access to the biliary system, code 47532 is reported for the percutaneous access and diagnostic cholangiogram. This may be referred to as a “PTC” or a “PTHC” (percutaneous transhepatic cholangiogram). Do not report 47531 or 47532 with 47533–47541 as diagnostic cholangiography is included in these therapeutic procedure codes.

This insight is just the tip of the iceberg for biliary tract and GI coding. As the pandemic eases and service volumes rebound, now more than ever it is imperative to make sure your CPT® coding is correct and compliant. Master more interventional radiology topics and break down the complexity with expert-infused insight. Our GI/Biliary Interventional Radiology Coding webcast on-demand is an essential training tool for both audio and visual learners.


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