How To Use CPT Code 47535

CPT 47535 describes the conversion of an external biliary drainage catheter to an internal-external biliary drainage catheter using a percutaneous approach. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 47535?

CPT 47535 can be used to describe the conversion of an external biliary drainage catheter to an internal-external biliary drainage catheter. This procedure is performed percutaneously, meaning it is done through the skin, and involves the use of imaging guidance such as ultrasound and/or fluoroscopy. The provider may also perform diagnostic cholangiography, which is a radiological procedure to image the inside of the bile ducts using a contrast dye.

2. Official Description

The official description of CPT code 47535 is: ‘Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation.’

3. Procedure

1. The provider begins by preparing and anesthetizing the patient.
2. Using ultrasound or image guidance, the provider inserts a needle into the liver through a puncture.
3. A guide wire is then inserted through the needle and advanced into the bile duct.
4. The existing catheter is advanced beyond any obstructions in the bile ducts and into the duodenum.
5. The guide wire is removed, and the catheter is left in place to drain bile into the small intestine.
6. The internal end of the catheter is secured, and the external end is attached to an external drainage system.
7. A compression bandage is applied at the puncture site.
8. If necessary, the provider may perform diagnostic cholangiography by injecting a contrast dye into the bile ducts to image their inside.
9. The procedure includes all radiological supervision and interpretation.

4. Qualifying circumstances

CPT 47535 is performed on patients who require the conversion of an external biliary drainage catheter to an internal-external catheter. This procedure is typically indicated when there is a need for both internal and external drainage of bile. The provider must use a percutaneous approach and perform the procedure with the assistance of imaging guidance, such as ultrasound or fluoroscopy. If diagnostic cholangiography is performed, it must be included in the procedure.

5. When to use CPT code 47535

CPT code 47535 should be used when the provider performs the conversion of an external biliary drainage catheter to an internal-external catheter using a percutaneous approach. This code should be reported when the procedure includes imaging guidance and, if performed, diagnostic cholangiography. It is important to review CPT and payer-specific guidelines to ensure accurate reporting.

6. Documentation requirements

To support a claim for CPT 47535, the provider must document the following information:

• Indication for the conversion of the external biliary drainage catheter to an internal-external catheter
• Use of imaging guidance, such as ultrasound or fluoroscopy
• Performance of diagnostic cholangiography, if applicable
• Date of the procedure
• Start and end time of the procedure
• Details of the procedure, including the steps performed
• Any complications or additional interventions
• Signature of the provider

7. Billing guidelines

When billing for CPT 47535, ensure that the procedure meets the criteria outlined in the official description. The code includes all associated radiological supervision and interpretation, so separate reporting of these services is not necessary. It is important to review CPT and payer-specific guidelines for any additional requirements or considerations when reporting this code.

8. Historical information

CPT 47535 was added to the Current Procedural Terminology system on January 1, 2016. There have been no updates to the code since its addition.

9. Examples

1. A patient with a biliary obstruction undergoes the conversion of an external biliary drainage catheter to an internal-external catheter using a percutaneous approach. The provider performs diagnostic cholangiography during the procedure to assess the extent of the obstruction.
2. During a follow-up visit, the provider determines that the external biliary drainage catheter needs to be converted to an internal-external catheter for better management of the patient’s condition. The procedure is performed percutaneously with the assistance of fluoroscopy.
3. A patient with a history of biliary drainage catheter placement presents with complications, and the provider decides to convert the external catheter to an internal-external catheter. The procedure is performed using ultrasound guidance.
4. After an initial biliary drainage catheter placement, the provider determines that converting it to an internal-external catheter would be more beneficial for the patient. The procedure is performed percutaneously, and diagnostic cholangiography is performed to evaluate the bile ducts.