CPT® Code 74327

Deleted

1. Indications

The procedure associated with CPT® Code 74327 is indicated for patients experiencing biliary obstruction due to the presence of calculi in the bile duct. The following conditions may warrant this procedure:

• Biliary Obstruction The presence of stones in the bile duct that obstruct the normal flow of bile, leading to symptoms such as jaundice, abdominal pain, or pancreatitis.
• Cholelithiasis The formation of gallstones that may migrate into the bile duct, necessitating removal to prevent complications.
• Cholangitis An infection of the bile duct that can occur due to blockage by a calculus, requiring intervention to clear the obstruction.

2. Procedure

The procedure for CPT® Code 74327 involves several key steps to ensure the successful removal of the biliary duct calculus:

• Preparation The patient is positioned appropriately, and the area of the T-tube tract is prepared for the procedure. This may involve sterilization of the skin and administration of sedation or anesthesia as needed.
• Imaging Guidance Radiological supervision is initiated, where X-ray images of the bile duct are taken to identify the location and size of the calculus. This imaging is crucial for guiding the subsequent steps of the procedure.
• Accessing the Biliary Duct A small catheter or instrument is inserted through the T-tube tract into the bile duct. This access point allows the physician to navigate to the site of the calculus.
• Removal of the Calculus Using a specialized tool, such as a basket or snare, the physician captures the calculus. The Burhenne technique may be employed here, which involves specific maneuvers to effectively grasp and extract the stone from the duct.
• Post-Removal Imaging After the calculus is removed, additional X-ray images may be taken to confirm that the duct is clear and to assess for any remaining stones or complications.
• Closure and Recovery Once the procedure is complete, the T-tube tract is managed appropriately, and the patient is monitored for recovery from sedation and any immediate post-procedure complications.

3. Post-Procedure

Following the procedure coded by CPT® 74327, patients are typically monitored for any signs of complications, such as bleeding or infection. The T-tube may remain in place for a period to allow for drainage of bile and to ensure that the duct remains patent. Patients may be advised on dietary modifications and follow-up appointments to assess the function of the biliary system and to monitor for any recurrence of calculi. Pain management may also be addressed as part of post-procedure care, ensuring that the patient is comfortable during recovery.