Q: What is the difference between biliary drainage using an ERCP approach and percutaneous biliary drainage?
A: When a biliary stent is placed in the biliary tree for drainage using an ERCP approach, a scope is inserted into the mouth and through the esophagus, stomach, and duodenum. The ampulla of Vater is cannulated and sphincterotomy may be performed to allow for the placement of a stent into one or more biliary ducts. Imaging is performed using a combination of endoscopy and radiological modalities. The stent allows the bile duct to empty into the duodenum.
By contrast, percutaneous biliary drainage is performed by puncturing through the skin directly into the bile duct using radiological guidance. The drainage tube can drain externally or can be a combination internal/external catheter.
Q: Would there ever be a time when balloon dilation could be coded separately from stenting of the biliary ducts?
A: Stent placement includes balloon dilation in the same duct. If balloon dilation and stenting are performed on separate ducts, both codes are assigned and modifier 59 (or XS) is appended to the dilation code.
Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Kristi also performs DRG and APC audits and is known for her vast knowledge on coding vascular interventional radiology procedures. Kristi has an extensive background in coding education and consulting and is a national speakers on topics related to ICD-10 and CPT coding as well as code-based reimbursement.