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Official Description

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; new access, with placement of separate biliary drainage catheter (eg, external or internal-external)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 47540 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 procedural steps including balloon dilation, catheter exchanges, and catheter removals as necessary. The procedure also encompasses all associated radiological supervision and interpretation, ensuring that the placement is performed safely and effectively. A key aspect of this procedure is the creation of new access to the bile duct, which is achieved by placing a separate biliary drainage catheter, either external or internal-external, to facilitate bile drainage. This comprehensive approach is essential for managing bile duct obstructions and ensuring proper biliary function.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The placement of stent(s) into a bile duct via CPT® Code 47540 is indicated for patients experiencing bile duct obstructions. These obstructions may arise from various conditions, including but not limited to:

  • Malignancy - Tumors that compress or invade the bile duct, leading to blockage.
  • Cholelithiasis - The presence of gallstones that can obstruct the bile duct.
  • Strictures - Narrowing of the bile duct due to previous surgeries, inflammation, or other pathological processes.
  • Pancreatitis - Inflammation of the pancreas that may affect the bile duct.

2. Procedure

The procedure for CPT® Code 47540 involves several detailed steps to ensure successful placement of the stent(s) into the bile duct:

  • Step 1: Preparation and Access - The skin over the insertion site is prepared, typically 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. An incision is made to facilitate access to the liver.
  • Step 2: Needle Insertion - A long, thin, flexible needle is inserted through the skin into the liver and advanced into the bile duct. This step is crucial for establishing access to the bile duct for further intervention.
  • Step 3: Contrast Injection - A small amount of contrast medium is injected through the needle to confirm its location within the bile duct. This imaging step is essential for visualizing the anatomy of the bile ducts.
  • Step 4: Guidewire Placement - A guidewire is passed through the needle into the bile duct, and the needle is subsequently removed, leaving the guidewire in place for further procedures.
  • Step 5: Cholangiography - An angiography catheter is passed over the guidewire, and dye is injected into the bile ducts. Radiographic images are taken to visualize the bile ducts and assess the extent of the obstruction.
  • Step 6: Balloon Dilation - A balloon catheter is inserted over the guidewire to the site of the stricture. The balloon is inflated to dilate the narrowed portion of the duct, facilitating the placement of the stent.
  • Step 7: Stent Placement - The stent(s) is advanced to the site of the stricture over the guidewire and placed within the bile duct. This stent is designed to maintain the duct open, allowing bile to flow into the small intestine.
  • Step 8: Drainage Catheter Placement - In addition to the stent, a separate biliary drainage catheter is placed. This may be an internal-external biliary drainage tube or an external transhepatic biliary drainage tube, depending on the clinical scenario.
  • Step 9: Final Imaging - Additional contrast is injected following the placement of the stent(s) and drainage catheter to ensure the patency of the bile duct. This final imaging confirms that the bile can flow freely through the newly established pathway.
  • Step 10: Collection Setup - The end of the drainage tube exiting the skin is attached to a collection bag for bile drainage, ensuring that any excess bile is appropriately managed post-procedure.

3. Post-Procedure

After the completion of the procedure, patients are typically monitored for any immediate complications. Post-procedure care may include managing the drainage catheter, ensuring that it remains patent and functioning correctly. Patients may also require follow-up imaging to assess the effectiveness of the stent placement and to monitor for any potential complications such as infection or re-obstruction. Instructions regarding care of the insertion site and signs of complications should be provided to the patient to ensure proper recovery and management.

Short Descr PERQ PLMT BILE DUCT STENT
Medium Descr PLMT BILE DUCT STENT PRQ NEW ACCESS W/SEP CATH
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; new access, with placement of separate biliary drainage catheter (eg, external or internal-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 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)
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).
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.
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.)
GC This service has been performed in part by a resident under the direction of a teaching physician
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)
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
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2017-01-01 Changed Long description changed and Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category.
2017-01-01 Changed Guideline added
2016-01-01 Added Added
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