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The procedure described by CPT® Code 47538 involves the placement of stent(s) into a bile duct through a percutaneous approach, which means that the procedure is performed through the skin. This intervention is primarily aimed at relieving obstructions in the bile duct, allowing bile to flow freely into the small intestine. The procedure includes several critical components: diagnostic cholangiography, which is an imaging technique used to visualize the bile ducts; imaging guidance, such as fluoroscopy or ultrasound, to assist in the accurate placement of the stent; and various steps like balloon dilation, catheter exchanges, and catheter removals, if necessary. Importantly, this procedure is performed using existing access, which typically refers to a previously placed transhepatic drainage catheter or T-tube that has already been secured in place. This existing access simplifies the process, as it eliminates the need for creating a new entry point into the bile duct. The overall goal of this procedure is to ensure that the bile duct remains open, thereby facilitating the normal flow of bile and preventing complications associated with bile duct obstructions.
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The placement of stent(s) into a bile duct via CPT® Code 47538 is indicated for patients experiencing obstructions in the bile duct. These obstructions may arise from various conditions, including but not limited to:
The procedure for the placement of stent(s) into a bile duct begins with the confirmation of existing access, such as a previously placed transhepatic drainage catheter or T-tube. The first step involves the injection of a small amount of contrast medium through the existing access to verify the location of the needle. Following this, a guidewire is carefully passed through the needle into the bile duct, and the needle is subsequently removed. If diagnostic cholangiography is indicated, an angiography catheter is then advanced over the guidewire into the bile duct. A contrast dye is injected to visualize the bile ducts on X-ray, allowing for the assessment of the obstruction and the flow of bile. Additional radiographic images are captured as the contrast flows through the bile ducts into the small intestine, providing further insight into the anatomy and any potential blockages.
Once the obstruction is confirmed, a balloon catheter is introduced over the guidewire to the site of the stricture. The balloon is inflated to dilate the narrowed portion of the duct, which helps to facilitate the placement of the stent. After dilation, the stent(s) is advanced over the guidewire and positioned within the bile duct at the site of the stricture. This stent serves to maintain the duct open, ensuring that bile can flow unobstructed into the small intestine. Following the placement of the stent(s), additional contrast may be injected to confirm the patency of the bile duct and ensure that the stent is functioning as intended. If necessary, a drainage catheter may also be placed, with its curled end positioned in the small intestine and the other end exiting through the skin for bile collection.
After the completion of the stent placement procedure, patients are typically monitored for any immediate complications or adverse reactions. It is essential to ensure that the stent is functioning correctly and that bile is flowing adequately into the small intestine. Patients may be advised on post-procedure care, which could include instructions on managing the drainage catheter if one has been placed, as well as signs and symptoms to watch for that may indicate complications, such as infection or obstruction. Follow-up imaging may be scheduled to assess the stent's position and the overall condition of the bile duct, ensuring that the obstruction remains resolved and that the bile flow is maintained.
| Short Descr | PERQ PLMT BILE DUCT STENT | Medium Descr | PLMT BILE DUCT STENT PRQ EXISTING ACCESS | Long Descr | Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation; existing access | 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 | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 2 |
This is a primary code that can be used with these additional add-on codes.
| 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). | 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). | 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. | 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. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 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.) | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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 | 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 | Long description changed and Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2016-01-01 | Added | Added |
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