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The CPT® Code 47533 refers to the procedure of placing a percutaneous biliary drainage catheter for external drainage. This procedure is typically indicated when there is a blockage in the bile ducts due to conditions such as stenosis, impacted stones, or tumors. The process begins with the preparation of the skin at the insertion site, which is usually located over the right midaxillary line below the tenth rib for access to the right hepatic lobe or over the epigastrium for access to the left hepatic lobe. A long, thin, flexible needle is then inserted through the skin into the liver and advanced into the bile duct. To confirm the correct placement of the needle, a small amount of contrast medium is injected. Following this, a guidewire is passed through the needle into the bile duct, allowing for the needle to be removed. If diagnostic cholangiography is performed, an angiography catheter is introduced over the guidewire, and dye is injected into the bile ducts, enabling visualization on X-ray. Additional radiographic images are captured as the contrast flows through the bile ducts into the small intestine. The procedure may also involve probing the bile duct and dilating any strictures before the biliary drainage catheter is inserted over the guidewire. The catheter is designed to facilitate the drainage of bile externally, with the end of the tube exiting the skin and connected to a collection bag. This code encompasses the entire process, including imaging guidance, contrast injection, and all associated radiological supervision and interpretation necessary for the successful placement of the biliary drainage catheter.
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The procedure associated with CPT® Code 47533 is indicated for the following conditions:
The procedure begins with the preparation of the skin at the designated insertion site, which is typically located over the right midaxillary line below the tenth rib for access to the right hepatic lobe or over the epigastrium for access to the left hepatic lobe. Once the area is prepped, a small incision is made to facilitate access. A long, thin, flexible needle is then carefully inserted through the skin and advanced into the liver, targeting the bile duct. To ensure accurate placement, a small amount of contrast medium is injected through the needle. This step is crucial as it confirms the needle's location within the bile duct. Following this, a guidewire is passed through the needle into the bile duct, allowing the needle to be removed. If diagnostic cholangiography is indicated, an angiography catheter is then introduced over the guidewire. Dye is injected into the bile ducts, which allows for visualization of the bile ducts on X-ray. Additional radiographic images are taken as the contrast medium flows through the bile ducts into the small intestine, providing further insight into the anatomy and any potential obstructions. During this process, the bile duct may be probed, and any strictures can be dilated to facilitate drainage. Once the necessary imaging and interventions are completed, the transhepatic biliary drainage catheter is inserted over the guidewire. This catheter is designed for external drainage, with the end exiting the skin and connected to a collection bag. If the drain cannot be maneuvered past the obstruction, an external transhepatic biliary drainage tube is placed proximal to the obstruction. After the catheter or tube is in place, additional contrast may be injected to confirm that the bile duct remains patent. This comprehensive procedure includes all necessary imaging guidance, contrast injections, and radiological supervision and interpretation.
After the placement of the biliary drainage catheter, patients are typically monitored for any complications related to the procedure. It is essential to ensure that the catheter is functioning correctly and that bile is draining as expected. The end of the catheter that exits the skin is connected to a collection bag to facilitate the external drainage of bile. Patients may require follow-up imaging to confirm the patency of the bile duct and the effectiveness of the drainage. Additionally, instructions regarding care of the catheter site and signs of potential complications, such as infection or obstruction, should be provided to the patient. Regular assessments may be necessary to evaluate the need for further interventions or adjustments to the drainage system.
| Short Descr | PLMT BILIARY DRAINAGE CATH | Medium Descr | PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL | Long Descr | Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; external | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | I1F - Standard imaging - other | MUE | 1 |
This is a primary code that can be used with these additional add-on codes.
| 47542 | Addon Code MPFS Status: Active Code APC N ASC N1 Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each duct (List separately in addition to code for primary procedure) | 47543 | Addon Code MPFS Status: Active Code APC N ASC N1 Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (eg, brush, forceps, and/or needle), including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, single or multiple (List separately in addition to code for primary procedure) | 47544 | Addon Code MPFS Status: Active Code APC N ASC N1 Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure) |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AG | Primary physician | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2016-01-01 | Added | Added |
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