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The procedure described by CPT® Code 47535 involves the conversion of an external biliary drainage catheter to an internal-external biliary drainage catheter. This conversion is typically performed to manage biliary obstruction, which can arise from various causes such as gallstones, tumors, infections, inflammation, or trauma. Initially, an external biliary drainage catheter is placed to relieve pressure and facilitate bile drainage from the biliary system. This catheter is inserted percutaneously through the skin, with its tip positioned above the obstruction, allowing bile to be collected in an external drainage bag. Once the obstruction has been adequately decompressed, the next step is to convert the external drainage system into an internal-external system. This conversion is performed under fluoroscopic guidance, which provides real-time imaging to assist in navigating the biliary anatomy. A guidewire is advanced through the existing catheter, traversing the obstructed area and reaching the duodenum. The original catheter is then removed, and a new catheter is inserted over the guidewire to ensure proper placement. During this process, a contrast dye may be injected through the catheter to perform a diagnostic cholangiography, which visualizes the biliary system and confirms that the catheter is correctly positioned past the obstruction into the duodenum. After the guidewire is removed, the catheter is secured to the skin, and a drainage bag is connected to the external portion of the catheter. This internal-external biliary drainage system allows for bile to flow in both directions, facilitating effective management of biliary drainage. The code 47535 encompasses all necessary imaging guidance, as well as the supervision and interpretation of the radiological images associated with this procedure.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 47535 is indicated for patients experiencing biliary obstruction due to various underlying conditions. The following are specific indications for performing this procedure:
The procedure for converting an external biliary drainage catheter to an internal-external biliary drainage catheter involves several critical steps, each essential for ensuring successful catheter placement and function:
Post-procedure care following the conversion to an internal-external biliary drainage catheter involves monitoring the patient for any complications and ensuring the proper functioning of the drainage system. Patients may be observed for signs of infection, leakage, or obstruction. It is essential to maintain the integrity of the catheter and the connection to the drainage bag. Follow-up imaging may be required to assess the position and function of the catheter, as well as to ensure that the biliary system is adequately draining. Patients should be educated on signs of potential complications and advised to report any unusual symptoms promptly. Regular follow-up appointments will be necessary to evaluate the ongoing need for the drainage system and to plan for any further interventions if required.
| Short Descr | CONVERSION EXT BIL DRG CATH | Medium Descr | CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH | Long Descr | Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation | 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) |
| 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | 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.) | AG | Primary physician | ET | Emergency services | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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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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