CPT® Code 74305 | Case2Code

Code deleted, use 47531

Official Description

Cholangiography and/or pancreatography; through existing catheter, radiological supervision and interpretation

Common Language Description

Cholangiography and pancreatography are specialized radiological procedures aimed at visualizing the bile ducts and pancreatic duct, respectively. These procedures are essential for diagnosing conditions such as stones, inflammation, or obstructions within these ducts. Cholangiography focuses on the bile ducts, which transport bile from the liver and gallbladder to the small intestine, while pancreatography examines the pancreatic duct, which carries digestive enzymes from the pancreas. Typically, these procedures are performed during biliary surgery or in the post-operative setting through a catheter that has already been placed. After the removal of the gallbladder, a small catheter is inserted into the cystic duct, which is responsible for draining bile from the gallbladder into the common bile duct. The pancreatic duct merges with the common bile duct just before entering the duodenum at the ampulla of Vater. The imaging process utilizes x-ray technology, which employs indirect ionizing radiation to capture images of the internal structures of the body. This method is effective because different tissues absorb x-rays to varying degrees based on their density and composition, allowing for the creation of detailed two-dimensional images. To enhance the visibility of the anatomical structures and their functions, a contrast material is injected into the ducts. This contrast agent improves the definition of the images, making it easier to identify any abnormalities. The entire procedure is conducted under the direct supervision of a radiologist, who oversees the injection of the contrast material and interprets the resulting images, providing critical information to the surgeon regarding the condition of the bile and pancreatic ducts. The specific CPT® code 74305 is designated for reporting the radiological supervision and interpretation of cholangiography and/or pancreatography when these procedures are performed post-operatively through an existing catheter or T-tube.

1. Indications

Cholangiography is indicated for the evaluation of bile duct stones, inflammation, or obstruction. It is particularly useful in cases where there is a need to assess the patency of the bile ducts following gallbladder surgery or in the presence of biliary disease. Pancreatography is indicated for visualizing the pancreatic duct to identify trauma, obstructions, or other pathological conditions affecting pancreatic function. Both procedures are performed to provide critical information that aids in the diagnosis and management of biliary and pancreatic disorders.

2. Procedure

Step 1: The procedure begins with the placement of a catheter into the cystic duct, which is done after the gallbladder has been surgically removed. This catheter serves as a conduit for the contrast material that will be injected during the imaging process.

Step 2: Once the catheter is in place, a radiologist prepares to inject a contrast agent into the bile ducts and/or pancreatic duct. This contrast material is essential for enhancing the visibility of the structures during the x-ray imaging.

Step 3: The radiologist administers the contrast material through the catheter while closely monitoring the injection process. This step is crucial as it ensures that the contrast is delivered effectively into the appropriate ducts.

Step 4: Following the injection of the contrast, x-ray images are taken. The radiologist utilizes x-ray technology to capture images of the bile and pancreatic ducts, allowing for the assessment of any abnormalities such as stones, strictures, or other obstructions.

Step 5: After the imaging is completed, the radiologist interprets the x-ray results and prepares a report detailing the findings. This report is then communicated to the surgeon, providing vital information for further management of the patient’s condition.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications that may arise from the catheter placement or contrast injection. Patients may be observed for signs of infection, bleeding, or adverse reactions to the contrast material. The recovery period may vary depending on the individual patient's condition and the complexity of the procedure. Follow-up imaging or additional interventions may be required based on the findings reported by the radiologist. It is essential for healthcare providers to ensure that the patient receives appropriate instructions regarding any necessary follow-up care and to address any concerns the patient may have following the procedure.

Short Descr	X-RAY BILE DUCTS/PANCREAS
Medium Descr	CHOLANGIO&/PANCREATOGRAPHY THRU CATH RS&I
Long Descr	Cholangiography and/or pancreatography; through existing catheter, radiological supervision and interpretation
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51)	0 - No 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)	0 - 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	T-Packaged Codes
Type of Service (TOS)	4 - Diagnostic Radiology
Berenson-Eggers TOS (BETOS)	I1D - Standard imaging - contrast gastrointestinal
MUE	Not applicable/unspecified.
CCS Clinical Classification	226 - Other diagnostic radiology and related techniques