Cholangiogram/plasty, biopsy, stone removal

Hi Guys,

Can you please help me with this? It looks like there was a lot going on.

PROCEDURES PERFORMED:

CHOLANGIOGRAM, BRUSH BIOPSY DISTAL COMMON BILE DUCT, STONE EXTRACTION

UTILIZING BASKET AND BALLOON TECHNIQUE, CHOLANGIOPLASTY, REINSERTION OF

BILIARY DRAINAGE CATHETER VIA T-TUBE TRACT

IMAGING MODALITY UTILIZED:

Fluoroscopy

ACCESS SITE:

T-tube tract

CATHETER POSITION:

Common bile duct

CONTRAST UTILIZED: Nonionic contrast utilized.

TECHNIQUE: The indwelling tube was sterilely prepped and draped in standard fashion.

Contrast was injected. There is a large oval filling defect identified in

the distal common bile duct. There are several small rounded filling

defects identified nested at the level of the pigtail catheter within the

common bile duct above the biliary enteric junction. The latter were felt

to likely reflect air bubbles. Catheter removed over a guidewire. An 8

French sheath inserted across the common bile duct. Through this, the

distal common bile duct was subsequently brushed using a standard brush

biopsy technique. Subsequently a standard biliary basket was placed and

attempts were made at engaging the presumed choledocholith in the distal

common bile duct. Multiple attempts were performed at positioning the

choledocholith into the bowel. It was difficult to image the

choledocholith due to the radiolucency of the stone. Followup injections

demonstrate a persistent filling defect which appears smaller, this suggest

possible stone fracture and/or possible displacement of portions of the

stone into the duodenum. Subsequently additional techniques were performed

including balloon push technique across the distal common bile duct

utilizing 8 x 20 and 10 x 20 mm balloons. Finally, completion balloon

cholangioplasty was performed using a 12 mm balloon. Balloon inflations

were for 5 minutes x 3. Completion study demonstrates patency of the

common bile duct. There are filling defects within the common bile duct

however these may be blood, underlying stone is not excluded. The patient

will undergo followup cholangiogram. Over the guidewire the sheath was

removed, and a 12 French Dawson-Mueller was placed in the mid common bile

duct. Dressing applied.

FINDINGS:

Cholangiogram demonstrates oblong filling defect in the distal common bile

duct which likely reflects a retained stone/choledocholith. As described

above, various techniques including basket, push balloon, and

cholangioplasty were utilized to fragment the stone in attempt to displace

the stone into the duodenum. Several small rounded defects were evident

nested at the level of the biliary drainage catheter, the latter felt to

likely reflect gas bubbles. Brush biopsy conducted along the level of the

distal common bile duct narrowing. Drainage catheter reinserted. The

patient will undergo followup diagnostic cholangiography to assess results

and need for further intervention.

I thought these codes would be appropriate, but the 47552 is editing against the 47630. I got: 47530/75984, 47630/74327, 47552, 47505/74305. What do you think? Thanks in advance for any help!!

Cholangiogram/plasty, biopsy, stone removal