CPT® Code 74328

Endoscopic catheterization of the biliary ductal system is a specialized medical procedure aimed at diagnosing or treating various conditions affecting the biliary ducts. These conditions may include biliary duct obstruction, dilation, inflammation, the presence of stones, or tumors. The biliary ductal system is a network that facilitates the drainage of bile produced in the liver. Bile flows from the liver through the left and right hepatic ducts, which converge to form the common hepatic duct. This duct then connects with the cystic duct from the gallbladder, ultimately forming the common bile duct. Approximately 50 percent of the bile generated in the liver is stored in the gallbladder before being released into the duodenum via the common bile duct. Additionally, the pancreatic duct merges with the common bile duct just before reaching the ampulla of Vater in the duodenum, allowing for the combined discharge of bile and pancreatic fluids through the papillary orifice. During the procedure, the patient is typically sedated, and an endoscope is inserted orally into the stomach, advancing it to the duodenal papilla. To facilitate the procedure, medications such as anti-cholinergics, glucagon, or nitroglycerin may be administered to relax the sphincter at the ampulla of Vater. A small catheter is then threaded through the endoscope to cannulate the ampulla, followed by the injection of contrast dye to visualize the biliary ductal system through X-ray imaging. The catheter is advanced over a guidewire into the common bile duct and biliary tract. This procedure is generally performed by a gastroenterologist, often in collaboration with a radiologist, to ensure accurate imaging and interpretation. The CPT® Code 74328 is specifically designated for reporting the radiological supervision and interpretation associated with this endoscopic catheterization of the biliary ductal system.