CPT® Code 47541

Placement of access through the biliary tree and into small bowel to assist with an endoscopic biliary procedure (eg, rendezvous procedure), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation, new access

The procedure described by CPT® Code 47541 involves the placement of access through the biliary tree and into the small bowel, specifically to assist with an endoscopic biliary procedure, such as a rendezvous procedure. This complex intervention is typically performed when standard endoscopic techniques, like endoscopic retrograde cholangiography (ERC) or endoscopic ultrasound-guided rendezvous procedure (EUS-RV), are insufficient to visualize the biliary duct opening. The procedure begins with the insertion of an endoscope through the patient's nose or mouth, advancing it into the stomach and small intestine to locate the duodenal papilla, where the biliary duct opens. If the duct cannot be visualized, an ultrasound transducer may be utilized to enhance the visualization of the biliary anatomy. In cases where endoscopic access fails, a new percutaneous access to the biliary tree is established using a small-gauge needle advanced through the skin into the liver. This allows for the injection of contrast dye to visualize the biliary system through cholangiography. The procedure is performed under imaging guidance, which may include ultrasound and/or fluoroscopy, ensuring accurate placement of the guidewire into the biliary duct. The comprehensive nature of this procedure, including all associated imaging guidance and radiological supervision, is encapsulated in the CPT® Code 47541, which reflects the complexity and technical skill required to successfully complete the intervention.