CPT® Code 47490

Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation

Cholecystostomy is a medical procedure that involves the creation of an opening into the gallbladder through the skin, typically performed in patients suffering from acute cholecystitis. This condition often affects critically ill patients who are not suitable candidates for more invasive surgical interventions, such as cholecystectomy. The procedure is conducted under imaging guidance, which may include ultrasound, fluoroscopy, or computed tomography (CT), ensuring precise placement of instruments. During the procedure, a local anesthetic is administered to minimize discomfort, and a small incision is made in the skin to access the abdominal cavity. The Seldinger technique is commonly employed, where a needle is carefully advanced into the abdomen and subsequently into the gallbladder. A guidewire is then threaded through the needle, allowing for the insertion of a catheter that facilitates drainage of the gallbladder. In some cases, a direct trocar technique may be utilized for access. The procedure may also involve the injection of contrast media into the cystic duct to visualize the bile ducts, followed by the acquisition of radiographic images for evaluation. The physician interprets these images to assess the condition of the gallbladder and surrounding structures. Depending on the clinical scenario, the catheter may either be removed after the procedure or left in place for ongoing drainage, providing critical management for the patient's condition.