This Year 47490 Shakes Up Your Cholecystostomy Coding

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This year, 47490 joined the ranks of "complete" interventional codes. This means the encounter requires just one code to represent the procedure and related cardiology services. Here's some important information on why CPT created this code and how you are expected to use it.


Take a look at what revised 47490 includes to earn $365


This year CPT revised 47490 so that it now represents the 'complete' service needed for percutaneous creation of an opening in the gallbladder.


Last year: 47490 -- Percutaneous cholecystostomy
This year: 47490 Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when carried out, and radiological supervision and interpretation.


Percutaneous cholecystostomy is a life-saving procedure used to buy time for patients who are too ill to undergo gallbladder removal. Medicare's national rate for 47490 runs around $365, and CMS assigned the code a 10-day global period. This means related E/M services on the day of the procedure (after decision for ...
... surgery) and for the 10 days following the procedure are not payable separately. As a matter of fact, two post procedure visits are factored into the fee.


To prevent denials, strike out RS&I note


Important: CPT is continuing their previous pattern of bundling the ancillary services that are normally part of the procedures, including radiological guidance. As part of the change to a 'complete' code, this year CPT adds a note with 47490 telling you not to report the code with 47505 (Injection procedure for cholangiography …) or with radiology codes 74305, 75989, 76942, 77002, 77012, or 77021.


Warning: It may be seen that your CPT manual contradicts itself in the notes under 47490. The manual states that you shouldn't report 47490 with 75989 (Radiological guidance [that is., fluoroscopy, ultrasound, or computed tomography], for percutaneous drainage [example, abscess, specimen collection], with placement of catheter, radiological supervision and interpretation).However immediately under that, many manuals have the line, "For radiological supervision and interpretation, use 75989."


According to AMA's published errata, that last sentence was printed incorrectly in CPT 2011. To rectify this, delete the information directing you to report 75989 for radiological supervision.
For more on this and for other specialty-specific articles to assist your radiology coding, sign up for a good medical coding resource like Coding Institute.