How To Use CPT Code 47538

CPT 47538 describes the placement of stent(s) into a bile duct through an existing percutaneous access, including diagnostic cholangiography, imaging guidance, balloon dilation, catheter exchange(s), and catheter removal(s) when performed, along with all associated radiological supervision and interpretation. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 47538?

CPT 47538 is used to describe the placement of stent(s) into a bile duct through an existing percutaneous access. This procedure involves the use of diagnostic cholangiography, imaging guidance, balloon dilation, catheter exchange(s), and catheter removal(s) when necessary. The purpose of this procedure is to keep the bile duct open and allow for proper drainage of bile into the duodenum.

2. Official Description

The official description of CPT code 47538 is: ‘Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation; existing access.’

3. Procedure

1. The healthcare provider prepares the patient for the procedure and administers anesthesia if necessary.
2. Using imaging guidance, such as fluoroscopy and/or ultrasound, the provider inserts a needle into the liver via an existing percutaneous route.
3. A guide wire is then inserted through the needle and advanced to the bile duct.
4. The provider advances a catheter/stent over the guide wire to the site of obstruction and withdraws the guide wire.
5. A balloon catheter may be used to dilate the obstructed bile duct, allowing for proper drainage of bile into the duodenum.
6. The provider removes the catheter, leaving the stent in place.
7. Additional stents may be placed in the same bile duct or in other bile ducts if necessary.

4. Qualifying circumstances

CPT 47538 is performed on patients who require the placement of stent(s) in their bile ducts. This procedure is typically done for patients with obstructions or other conditions that impede the normal flow of bile. The patient must have an existing percutaneous access for the procedure to be performed. It is important to note that CPT 47538 should not be reported in conjunction with CPT codes 47536 and 47537 for the same percutaneous access.

5. When to use CPT code 47538

CPT code 47538 should be used when a healthcare provider performs the placement of stent(s) into a bile duct through an existing percutaneous access. This code should not be used if the procedure involves the placement of double-barrel stents in a single duct, multiple stents in different bile ducts through the same percutaneous access, or the placement of a stent through another stent. In such cases, modifier 59 should be appended to indicate a distinct procedure or service.

6. Documentation requirements

To support a claim for CPT 47538, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the placement of stent(s) in the bile duct
• Details of the procedure, including the use of diagnostic cholangiography, imaging guidance, balloon dilation, catheter exchange(s), and catheter removal(s)
• Date of the procedure and the start and end times
• Any additional procedures performed, such as the placement of additional stents
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 47538, ensure that the procedure meets the criteria outlined in the official description. It is important to note that this code includes imaging guidance and supervision and interpretation, so separate coding for radiology services is not necessary. Modifier 59 should be appended if the procedure involves specific circumstances, as mentioned earlier. It is also important to follow CPT and payer-specific guidelines for accurate billing.

8. Historical information

CPT 47538 was added to the Current Procedural Terminology system on January 1, 2016. There was a code change on January 1, 2017, which modified the description of the code to specify the placement of each stent through an existing access.

9. Examples

1. A patient with a bile duct obstruction undergoes the placement of a stent through an existing percutaneous access to restore proper bile flow.
2. A healthcare provider performs the placement of stent(s) in multiple bile ducts through the same percutaneous access to address obstructions in each duct.
3. Using imaging guidance, a provider places a stent through an existing stent to ensure proper drainage of bile.
4. A patient with a double-barrel stent in a single duct requires the placement of additional stents to address the obstruction.
5. A healthcare provider performs the placement of stent(s) in different bile ducts through the same percutaneous access to address multiple obstructions.