How To Use CPT Code 47542

CPT 47542 describes the percutaneous balloon dilation of the biliary duct(s) or the ampulla (sphincteroplasty) procedure, including imaging guidance and all associated radiological supervision and interpretation. 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 47542?

CPT 47542 is used to describe the percutaneous balloon dilation of the biliary duct(s) or the ampulla (sphincteroplasty) procedure. This procedure involves widening the biliary duct or performing surgical repair and reconstruction of the ampulla of Vater using a balloon catheter. The procedure is guided by imaging, such as fluoroscopy, and includes all radiological supervision and interpretation.

2. Official Description

The official description of CPT code 47542 is: ‘Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each duct (List separately in addition to code for primary procedure)’

Notes: (Use 47542 in conjunction with 47531, 47532, 47533, 47534, 47535, 47536, 47537, 47541) (Do not report 47542 in conjunction with 43262, 43277, 47538, 47539, 47540, 47555, 47556) (Do not report 47542 in conjunction with 47544 if a balloon is used for removal of calculi, debris, and/or sludge rather than for dilation) (For percutaneous balloon dilation of multiple ducts during the same session, report an additional dilation once with 47542 and modifier 59, regardless of the number of additional ducts dilated) (For endoscopic balloon dilation, see 43277, 47555, 47556)

3. Procedure

1. The provider prepares the patient for the procedure and administers anesthesia.
2. An endoscope is inserted through the patient’s mouth and down into the duodenum and biliary duct.
3. A balloon-tipped catheter is passed through the endoscope and positioned at the site of the stricture or sphincter.
4. The balloon is inflated to dilate the narrowed duct or sphincter, allowing for improved bile flow.
5. The provider may close the incision with sutures.

4. Qualifying circumstances

CPT 47542 is performed on patients with narrowed bile ducts (strictures) or sphincter-related issues. The procedure is typically performed percutaneously, meaning it is done through the skin, using image guidance such as fluoroscopy. It is important to note that CPT 47542 should not be reported in conjunction with certain other codes, as specified in the notes.

5. When to use CPT code 47542

CPT code 47542 should be used when a provider performs percutaneous balloon dilation of the biliary duct(s) or the ampulla (sphincteroplasty) procedure. It is important to review the specific documentation and guidelines to determine if this code is appropriate for the given scenario.

6. Documentation requirements

To support a claim for CPT 47542, the provider must document the following information:

• Reason for the procedure, such as a narrowed bile duct or sphincter-related issue
• Details of the procedure performed, including the use of a balloon catheter and any additional techniques or interventions
• Date of the procedure
• Imaging guidance used, such as fluoroscopy
• Radiological supervision and interpretation
• Any additional procedures or interventions performed during the same session
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 47542, it is important to ensure that the documentation supports the performance of the procedure and the use of imaging guidance. This code should not be reported in conjunction with certain other codes, as specified in the notes. It is also important to review payer-specific guidelines for any additional requirements or considerations.

8. Historical information

CPT 47542 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 undergoes percutaneous balloon dilation of a narrowed biliary duct to improve bile flow.
2. A provider performs percutaneous sphincteroplasty of the ampulla using a balloon catheter to address sphincter-related issues.
3. A patient with a biliary stricture undergoes percutaneous balloon dilation to widen the narrowed duct.
4. A provider performs percutaneous balloon dilation of multiple biliary ducts during the same session to address multiple strictures.
5. A patient undergoes percutaneous balloon dilation of the ampulla to improve bile flow and address sphincter-related issues.