47490 joined the ranks of "complete" interventional codes this year. This means the encounter requires just one code to represent the procedure and related radiology services. Read on for vital 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
CPT 2011 revised 47490 so that now it represents the 'complete' service needed for percutaneous creation of an opening in the gallbladder:
Last year: 47490 - Percutaneous cholecystostomy
This year: 47490 - Cholecystostomy, percutaneous, total procedure, including imaging guidance, catheter placement, cholecystogram when carried out, and radiological supervision & interpretation.
Percutaneous cholecystostomy is a life-saving procedure used to buy time for patients who are too ill to undergo gall bladder removal. Medicare's national rate for 47490 hovers around $365, and CMS allots the code a 10-day global period. This means related E/M services on the day of the procedure (post decision for surgery) and for the 10 days following the procedure are not payable separately. In actual fact, two post-procedure visits are factored into the fee.
Strike out RS&I note to avoid denials
CPT is continuing its earlier pattern of bundling the ancillary services that are normally part of procedures, including radiological guidance. As part of the change to a complete code, CPT 2011 adds a note with 47490 informing you not to report the code with 47505 or with radiology codes 74305, 75989, 76942, 77002, 77012, or 77021.
Caveat: You may see that your CPT manual contradicts itself in the notes under 47490. According to the manual, you shouldn't code 47490 with 75989. However straight away under that, many manuals have the line, 'for radiological supervision and interpretation, use 75989.'
That last sentence was wrongly printed in CPT 2011 , as per AMA's published errata. To rectify this inaccuracy, delete the information pointing you to report 75989 for radiological supervision.
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