CPT Laparoscopic cholesystectomy with cholangiography

[louise]

Oh my, I think I'm missing something really fundamental here. Help!

For discussion purposes, let's use 47563 lap cholecystectomy w/ cholangiography.
Under 74300 - Cholangiography and/or pancreatography; intraoperative, radiological supervision and interpretation it states (For procedure see 47505,48400,47560-47561, 47563)

My question is: I thought the cholangiography was already included in 47563???

Thanks everyone,
Louise

 

[Laureen]

47563 is the procedure. 74300 is the radiology piece not the procedure it self. The phrase "radiological supervision and interpretation" is your clue that it is the radiology piece to the overall service.

 

[louise]

That makes sense! But please explain why 47563 is cholecystectomy w/ [AND!] cholangiography? That seems to me that the cholangiography is already part of 47563. It seems that 47563 is a procedure AND a radiologic piece. How does 74300 fit into that?

 

[Laureen]

I know exactly what you are saying - I struggled with that at first too. It is WITH cholangiography (imaging of vessels around gall bladder) but the surgeon doesn't do the imaging - a radiologist does. It is a two part story - if it was just a regular cholecystectomy without the imaging then you'd use code 47600. But to report the imaging piece you need the matching code from radiology.

Findacode says "Use 47605if intraoperative cholangiography is also performed by placing a small catheter into the cystic duct, instilling 10-20 ml of contrast, and then visualizing the ducts using fluoroscopy."

The part I bolded is the part the surgeon would do. But there is a radiologic supervision part to this and that is reported with 74300.

 

[louise]

So if the surgeon is injecting the contrast (47605) and interpreting the results in real-time (74300), what part is the radiologist doing? Sitting beside the x-ray (fluoro) machine.....operating it. Right?
If the surgeon bills 47605 and 74300, would the radiologist bill 47605-TC?

 

[elenipete]

So if a code has a radiologic piece included, does that mean a radiologist is usually present during these types of procedures? And if not would the surgeon code both the procedure code and the radiology code?

 

[Laureen]

Findacode says "The physician takes and examines X-ray images of the gall bladder or pancreas during a procedure to remove the targeted organ. A special dye is injected prior to the X-ray imaging to show more details"

 

[elenipete]

Findacode says "The physician takes and examines X-ray images of the gall bladder or pancreas during a procedure to remove the targeted organ. A special dye is injected prior to the X-ray imaging to show more details"

So is the doctor reporting both the procedure code and the radiology code?

 

[Laureen]

https://www.cco.us/forum/threads/radiologic-s-i-question.104/

https://www.cco.us/medical-coding-certification-radiology-supervision-and-interpretation/

 

[elenipete]

https://www.cco.us/forum/threads/radiologic-s-i-question.104/

https://www.cco.us/medical-coding-certification-radiology-supervision-and-interpretation/[/QUOTE

THANK YOU!!
it is starting to click!!!!
Thank you for your patience with me!