How To Use CPT Code 47536

CPT 47536 describes the exchange of a biliary drainage catheter, whether external or internal-external, or the conversion of an internal-external catheter to external only. 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 47536?

CPT 47536 can be used to describe the exchange of a biliary drainage catheter, whether external or internal-external, or the conversion of an internal-external catheter to external only. This procedure allows for the drainage of bile, a substance produced in the liver and stored in the gallbladder that helps break down food. The provider performs this procedure using a percutaneous access route, meaning through the skin, and utilizes imaging guidance such as fluoroscopy or ultrasound. Diagnostic cholangiography, a radiological procedure to image the inside of the bile ducts, may also be performed during this procedure.

2. Official Description

The official description of CPT code 47536 is: ‘Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation.’

3. Procedure

1. The provider begins by appropriately prepping and anesthetizing the patient.
2. Using ultrasound or image guidance, the provider inserts a needle into the liver via a puncture and advances it to the bile duct.
3. Through the needle, the provider inserts a guide wire and removes it after advancing the drainage catheter.
4. The provider may remove an existing external or internal-external drainage catheter and replace it with another.
5. Alternatively, the provider may convert an internal-external catheter to external only by pulling the internal end back from the duodenum into the bile duct.
6. The provider attaches the outer end of the catheter to an external drainage system.
7. If necessary, the provider may perform diagnostic cholangiography by injecting a contrast dye into the bile ducts to image the inside of the ducts.
8. After completing the procedure, the provider secures the catheter with stitches and applies a compression bandage at the puncture site.

4. Qualifying circumstances

CPT 47536 is used for patients who require the exchange of a biliary drainage catheter or the conversion of an internal-external catheter to external only. The procedure is performed percutaneously, meaning through the skin, and requires imaging guidance such as fluoroscopy or ultrasound. The provider may also perform diagnostic cholangiography during the procedure. It is important to note that CPT 47536 should not be reported in conjunction with CPT 47538 for the same access, and if additional catheter exchanges are performed during the same session, modifier 59 should be appended to each additional exchange.

5. When to use CPT code 47536

CPT code 47536 should be used when the provider performs the exchange of a biliary drainage catheter, whether external or internal-external, or the conversion of an internal-external catheter to external only. This code should not be reported with CPT codes 47531 or 47532, as CPT 47536 includes diagnostic cholangiography.

6. Documentation requirements

To support a claim for CPT 47536, the provider must document the following information:

• Patient’s diagnosis and the need for the exchange or conversion of the catheter
• Type of catheter exchanged or converted
• Date of the procedure
• Start and end time of the procedure
• Imaging guidance used, such as fluoroscopy or ultrasound
• Performance of diagnostic cholangiography, if applicable
• Any associated radiological supervision and interpretation
• Details of the procedure, including any complications or additional interventions
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 47536, ensure that the procedure meets the criteria for the exchange or conversion of a biliary drainage catheter. The procedure should be performed percutaneously with imaging guidance and may include diagnostic cholangiography. It is important to review CPT and payer-specific guidelines for any additional requirements. CPT 47536 should not be reported with CPT codes 47531 or 47532, as it includes diagnostic cholangiography. Modifier 59 should be appended to each additional catheter exchange performed during the same session.

8. Historical information

CPT 47536 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 provider exchanges an external biliary drainage catheter for a patient with obstructive jaundice.
2. A provider converts an internal-external biliary drainage catheter to external only for a patient with a bile duct stricture.
3. A provider performs diagnostic cholangiography and exchanges an external biliary drainage catheter for a patient with choledocholithiasis.
4. A provider converts an internal-external biliary drainage catheter to external only and performs diagnostic cholangiography for a patient with a pancreatic pseudocyst.
5. A provider exchanges an external biliary drainage catheter for a patient with primary sclerosing cholangitis.
6. A provider converts an internal-external biliary drainage catheter to external only and performs diagnostic cholangiography for a patient with a biliary leak.
7. A provider exchanges an external biliary drainage catheter for a patient with a bile duct stricture following liver transplantation.
8. A provider converts an internal-external biliary drainage catheter to external only for a patient with a biliary stricture due to chronic pancreatitis.