CPT® Code 47535

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

The procedure described by CPT® Code 47535 involves the conversion of an external biliary drainage catheter to an internal-external biliary drainage catheter. This conversion is typically performed to manage biliary obstruction, which can arise from various causes such as gallstones, tumors, infections, inflammation, or trauma. Initially, an external biliary drainage catheter is placed to relieve pressure and facilitate bile drainage from the biliary system. This catheter is inserted percutaneously through the skin, with its tip positioned above the obstruction, allowing bile to be collected in an external drainage bag. Once the obstruction has been adequately decompressed, the next step is to convert the external drainage system into an internal-external system. This conversion is performed under fluoroscopic guidance, which provides real-time imaging to assist in navigating the biliary anatomy. A guidewire is advanced through the existing catheter, traversing the obstructed area and reaching the duodenum. The original catheter is then removed, and a new catheter is inserted over the guidewire to ensure proper placement. During this process, a contrast dye may be injected through the catheter to perform a diagnostic cholangiography, which visualizes the biliary system and confirms that the catheter is correctly positioned past the obstruction into the duodenum. After the guidewire is removed, the catheter is secured to the skin, and a drainage bag is connected to the external portion of the catheter. This internal-external biliary drainage system allows for bile to flow in both directions, facilitating effective management of biliary drainage. The code 47535 encompasses all necessary imaging guidance, as well as the supervision and interpretation of the radiological images associated with this procedure.