Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'.This can arise in two main ways: The balloon was then inflated within the gallbladder to secure it in place (Figure 2). flexible sigmoidoscopy (CPT code 45350) or colonoscopy (CPT code 45398), control of bleeding is not separately reportable with CPT codes 45334 (Flexible sigmoidoscopic control of bleeding) or 45382 (Colonoscopic control of bleeding) respectively. . With the new codes added in 2016, a comprehensive set of biliary codes is now available to describe almost every procedure performed in the biliary system. The following list(s) of codes is provided for reference purposes only and may not be all inclusive. They returned to the hospital for interval laparoscopic cholecystectomy. Epub 2014 Jan 29. 8600 Rockville Pike The .gov means its official. Unable to load your collection due to an error, Unable to load your delegates due to an error. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. This allows for performing interval laparoscopic cholecystectomy in a safe manner. ksam?mUUe , Percutaneous cholecystostomy is the image-guided placement of a drainage catheter into the gallbladder lumen. Cited Here | David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC, or Dr. Z, is the founder and CEO of ZHealth, LLC, and ZHealth Publishing, LLC. Trocar Cholecystostomy. Bookshelf 0000283275 00000 n Patient underwent simple incision of the lingual frenum to free the tongue. 2 weeks later a cholecystostomy tube check was performed showed persistent cystic duct obstruction. 0000277292 00000 n Z codes represent reasons for encounters. Figure 2 Laparoscopic cholecystostomy tube. 2014 Apr;24(4):261-4. doi: 10.1089/lap.2013.0292. As the patient was septic and high risk for cardiac complications, he underwent placement of percutaneous cholecystostomy tube by IR. (not the gallbladder). 0000188361 00000 n To determine long-term clinical outcomes following percutaneous cholecystostomy tube (PCT) placement. There are 14 new biliary intervention codes for 2016 (see New Biliary Intervention Codes for 2016). At the time of surgery, three of the 100 patients had gallbladders judged too severely inflamed for laparoscopic cholecystectomy. No part of this content may be reproduced or transmitted in any form or by any means as per the standard guidelines of fair use 0000265253 00000 n Work up was suspicious for acute cholecystitis. LC tube placement can be a safe alternative in such situations to avoid complications and conversion to open procedure. Acute cholecystitis and recurrent biliary colic are the most common indications for performing laparoscopic cholecystectomy. Twelve biliary CPT codes were deleted for 2016 (47500, 47505, 47510, 47511, 47525, 47530, 47630, 74305, 74320, 74327, 75980, and 75982), and five previously recommended endoscopic codes (47552, 47553, 47554, 47555, and 47556) should no longer be used for percutaneous procedures because new codes more accurately describe these procedures. 527 0 obj <> endobj -, J Fla Med Assoc. 530.4 Perforation of Esophagus (ICD 9) ICD-10 Code K22.4 Dyskinesia of Esophagus. This will drain blocked and infected gallbladder fluid. 0000265361 00000 n :>4@s9`t8m6e33333333=(zPWWA.=({PAE=({P`ooooo 0000304051 00000 n The role of a colon resection in combination with a Malone appendicostomy as part of a bowel management program for the treatment of fecal incontinence. 0000264931 00000 n CPT Code For Laparoscopic Cholecystectomy With Intraoperative Fluoroscopic Cholangiography Surg Endosc. Historically, surgical options have included the Malone antegrade continence enema, using an appendicostomy for antegrade colonic enemas. 0000211544 00000 n 47535 Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation Specimen: gallbladder fluid sent for culture. This month, well discuss the major changes in percutaneous biliary interventional coding. Control of postoperative pain, nausea, and vomiting are important to successful same day discharge, and admission rates despite planned same day discharge are reported to be 1-39%; patients older than age 50 may be at increased risk for admission (Kasem, et al. 4. 0000012605 00000 n 40810. Patient subsequently underwent interval cholecystectomy, when the inflammation had subsided. registered for member area and forum access. Procedure: Laparoscopic cholecystectomy with drain insertion. -. Halleran DR, Sloots CEJ, Fuller MK, Diefenbach K. Semin Pediatr Surg. Case 2 Patient is a 49-year-old female with a history of GERD, C-section 0000010849 00000 n 0000214528 00000 n CPT code 47563 describes a diagnostic laparoscopy and surgical removal of the gallbladder with the additional work of an intraoperative cholangiography. 57-year-old female who presented with perforated acute cholecystitis status post cholecystostomy tube placement on 10/19/2009. They therefore underwent laparoscopic placement of a cholecystostomy tube. 0000205882 00000 n As CPT Assistantnotes, however, that for some patients: replacing a G-tube is more complicated, such as when a gastrostomy tract has not matured or when the G-tube has been out for many hours or in cases where cooperation of the patient is difficult, as in some children or confused patients. New Add-on Codes What is documented here is not a percutaneous procedure. 0000264825 00000 n Figure 2 Laparoscopic cholecystostomy tube. It also provides access for diagnostic cholangiography. If I am stuck with an unlisted code, would it be best to simply code for the diagnostic laparoscopy and call the drain placement inclusive? The drainage tube will be connected to a collection bag which can be periodically emptied. Procedure: Diagnostic laparoscopy, cholecystostomy tube placement (14Fr mic feeding tube) Anesthesia: General Surgery. The cholangiogram codes may be used as a base code for +47542, +47543, and +47544, but only if a catheter is not placed, replaced, or converted. Laparoscopic tube cholecystostomy: still useful in the management of complicated acute cholecystitis. The stent codes may be used more than two times in individuals requiring multiple stents to treat multiple stenoses in different ducts. 1133- Budapest. Surgeons should be aware that an unlisted procedure requires documentation that provides relevant information, including a proper definition . HHS Vulnerability Disclosure, Help Epub 2006 Feb 27. would be reported with code 43763. Unable to load your collection due to an error, Unable to load your delegates due to an error. 0000011145 00000 n No Intervention: no drain insertion. 20 While percutaneous cholecystostomy may be used as the primary therapy in the critically ill patient unfit for surgery, there is a rapidly growing body of literature that advocates cholecystostomy as the initial treatment of choice for . The balloon was inflated within the gallbladder to secure it in place. )GxGxGxGxGxGCa #1. So if a laparoscopic biopsy of the liver is performed at the same time as another laparoscopic procedure, unlisted code 47379 should be reported, as there is no CPT code for a laparoscopic liver biopsy. Primary closure versus T-tube drainage in laparoscopic common bile duct exploration: a meta-analysis of randomized clinical trials. In March, we covered urinary intervention. 0000010421 00000 n 0000102023 00000 n 2015 Dec;25(6):e180-3. 0000101850 00000 n It is performed under x-ray or ultrasound. 0000008395 00000 n The procedure was started laparoscopically in 16 and open in 8 patients. New Code for Rendezvous Procedure oFT52HJm9` @C{7k^$3d4o^7|q'pKxHZ:a[0z-c(]Z%%3FchJta Patient recovered quite well and was discharged home on postop day 2 after the JP drain was removed. The authors have no conflicts of interest to declare. Appreciate any help you all can give me. The procedure is reported with 47532 when performed via a new access, or with 47531 when performed via an existing access. The patients received 48 h of antibiotics in the hospital and then underwent tube drainage for 4-6 weeks as outpatients. 0000287887 00000 n 0000263069 00000 n /E'q+H]8 Q@:g. A percutaneous cholecystostomy is a procedure to place a drainage catheter in the gallbladder through a tiny entry hole made in the stomach wall. Access placement to assist with endoscopic biliary procedure Because of add-on code edits, it may not be possible to submit +47542 with a biliary stent code (47538-47540), even when done in different ducts. Patient is a 49-year-old female with a history of GERD, C-section and hysterectomy-presenting with right upper quadrant pain for 2 days. Diagnosis of acute cholecystitis was made. 47531 Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; existing access CPT Code For Cholecystostomy Tube Removal Cholecystostomy tube is placed inside the bladder for decompression of infected, distended and inflamed gallbladder. They therefore underwent laparoscopic placement of a cholecystostomy tube. Hence decided to perform LCtube placement. -, Endoscopy. 0000278728 00000 n Fecal incontinence is a debilitating problem for many children, especially those with anorectal malformations. No tubes are left in place at the end of the procedure (add 47537 for tube removal, delete 47531 as bundled with tube removal). endstream endobj 538 0 obj <> endobj 539 0 obj <> endobj 540 0 obj <> endobj 541 0 obj <> endobj 542 0 obj <> endobj 543 0 obj <> endobj 544 0 obj [/DeviceN[/Cyan/Magenta/Yellow]/DeviceCMYK 582 0 R 584 0 R] endobj 545 0 obj [/Indexed/DeviceCMYK 179 585 0 R] endobj 546 0 obj [/Indexed/DeviceCMYK 119 586 0 R] endobj 547 0 obj [/Indexed/DeviceCMYK 231 587 0 R] endobj 548 0 obj [/Indexed/DeviceCMYK 250 588 0 R] endobj 549 0 obj [/Indexed/DeviceCMYK 74 589 0 R] endobj 550 0 obj [/Indexed/DeviceCMYK 74 590 0 R] endobj 551 0 obj <> endobj 552 0 obj <> endobj 553 0 obj <> endobj 554 0 obj [573 0 R] endobj 555 0 obj <>stream The .gov means its official. Laparoscopic cholecystostomy for acute acalculous cholecystitis. +47542 Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each duct (List separately in addition to code for primary procedure) At the end of the procedure, a new external biliary drainage catheter is placed over the guidewire due to excessive bleeding during the procedure (This is bundled with internal biliary stent placement.). Code 47490 describes insertion of "tube into . Laparoscopic cholecystectomy is the best treatment for acute calculus cholecystitis and the procedure should ideally be performed within 72 hours. Do not use this code for removal of debris or sludge, and do not use it with an attempted procedure modifier if stone retrieval is attempted, but no stones are identified. 0000212119 00000 n Three add-on procedures: 0000006018 00000 n Curr Urol Rep. 2019 Jun 10;20(8):41. doi: 10.1007/s11934-019-0909-1. Anticipating difficult cholecystectomy. Surgery was recommended. 0000285179 00000 n 0000006684 00000 n As it grows further, it may compromise additional ducts requiring three or four catheters for successful drainage). The codes are distinguished by the necessity to revise the gastrostomy tract when replacing the tube. Submit 47537 once for each catheter removed at the same session. +47543 describes an endoluminal biopsy (brush, needle, or alligator forceps) of the biliary ductal system (common bile duct, intrahepatic bile ducts). New Biliary Intervention Codes for 2016 National Library of Medicine How do I bill this? Please enable it to take advantage of the complete set of features! and transmitted securely. CMS categorizes this code as a "Type II Add-on Code". 0000266148 00000 n MOJ Clin Med Case Rep . This may limit the number of cholangioplasties submitted in patients with sclerosing cholangitis. I think the new incision does count, and the code includes the imaging but I don't think the imaging needs to happen per se. Date: Dec 14, 2018. As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. JavaScript is disabled. use codes 47505,74305,47525,75984 for tube check and change of cholecystostomy tube if the tube was . These procedures are more complicated and . Appendectomy or laparoscopic appendectomy CPT code(s): 44950, 44955, 44960, 44970 Cholecystectomy or laparoscopic cholecystectomy, Cholecystectomy or laparoscopic cholecystectomy CPT code(s): 47562, 47563, 47564, 47600, 47605, 47610, 47612, 47620. Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) with stent +CPT Code 47550 is an Add-On code and must be reported with a primary procedure. You are using an out of date browser. CPT Code For Laparoscopic Cholecystectomy With Firefly Firefly is used to inject a dye named ICG . Instead, CPT introduced two new codes to better reflect the work involved when replacing gastrostomy tubes: 43762 Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance;not requiring revision of gastrostomy tract Pressure necrosis of the underlying skin also complicates G-tube replacement. 43763 requiring revision of gastrostomy tract. A search of the hospital's radiology information service was performed using the keywords "percutaneous cholecystostomy," "gallbladder drain," and "cholecystostomy tube" and the relevant Current Procedural Terminology codes. 0000262534 00000 n The CPT code is 47564. 0000003466 00000 n When done via an existing access, submit a code describing a catheter exchange, removal, or conversion (e.g., 47535-47537). hbbc`b``3 1 Example: The patient has an internal/external catheter in place via a left anterior duct approach. 0000102401 00000 n Citation: cheeyandira A. Laparoscopic cholecystostomy tube placement. Early surgery is associated with better results in comparison to delayed surgery.1, Acute cholecystitis tends to be one of the highest risks for conversion to open surgery-due to unclear anatomy, excessive bleeding or technical complications.2,3, LC tube placement remains an alternative to open surgery in cases where the gallbladder is too inflamed to allow for laparoscopic removal, and in cases where the patient is too sick to tolerate a more extensive procedure. The opportunity for coding specificity has never been better. Agastrostomy tube, or G-tube, is atube inserted through the abdomen to deliver nutrition directly into the stomach. CPT 2016:Percutaneous Biliary Interventional Coding, Tech & Innovation in Healthcare eNewsletter, Capture the Complete Clinical Picture With Precision, Applying RVUs to Pharmacists Patient Care Services, Three Tidbits Help You Code Lesion Biopsy and Removal, Consider All Factors when Coding Colonoscopies, Mohs Micrographic Surgery for Clear Coding, Members Tip: Pain-free Coding of Mortons Neuroma. J Laparoendosc Adv Surg Tech A. 0000081587 00000 n 0000269288 00000 n 1991 Mar;161(3):339-44 It also provides access for diagnostic cholangiography.4. The three patients underwent successful interval laparoscopic cholecystectomy. Initial Biliary Stent Placements 0000264081 00000 n 0000265145 00000 n Dr. Z is Board Certified in Radiology with the Certification of Added Qualification (CAQ) in Interventional Radiology (ABR) (1995, 2005). 47538 Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each stent; existing access 0000268027 00000 n 0000266889 00000 n LC tube placement can be used as an alternative to open cholecystectomy in technically difficult cases and alternative to IR percutaneous cholecystostomy in rural hospitals without interventional radiology services.5 There are other indications for LC tube placement -such as in children with complicated choledochal cyst- where LC tube placement followed by laparoscopic cyst excision is a useful and safe procedure for the treatment of complicated choledochal cyst. 47536 Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation Postcholecystectomy syndrome. Federal government websites often end in .gov or .mil. If multiple bile ducts are biopsied, do not report additional procedure codes because all ducts biopsied are described by using this single code. 0000232694 00000 n Code +47544 may be used for stone extraction from the gall bladder via a cholecystostomy tube. 0000006160 00000 n Cholangioplasty is bundled when performed at the same site as a biliary stent deployment. Ultrasound scan of the liver showed thickening of the gallbladder with gallbladder stones. This article includes all medical codes you will need to report right hip pain and related specific ICD 10 & 11 codes. 0000263974 00000 n Patient had CT scan on 10/21/2009 demonstrating a persistent . Mayo Clinic Press. Percutaneous transhepatic gallbladder drainage (PTGBD) is indicated for patients with acute cholecystitis (AC) who are not indicated for urgent surgery, but external tubes reduce quality of life (QOL) while waiting for elective surgery. Heres what you need to know to be sure your coding is current and correct. Submit 47533 once for each external biliary drainage catheter placed via a new access at the same session. 0000264613 00000 n 1996 Jun;10(6):673-5. doi: 10.1007/BF00188528. Of the 100 patients in the study, conversion to open cholecystectomy was not necessary for any of the patients. The coding advice may or may not be outdated. For inpatient claims, report the diagnosis code for laparoscopic cholecystectomy. Clipboard, Search History, and several other advanced features are temporarily unavailable. This is the American ICD-10-CM version of K91.5 - other international versions of ICD-10 K91.5 may differ. Langenbecks Arch Surg 2012; 397:909. Deleted and Revised Biliary Codes sharing sensitive information, make sure youre on a federal If the gastrostomy tract has had time to mature (eg, at least four-weeks old), and the G-tube has not been removed for more than four to six hours, a replacement tube may be placed through the same gastrostomy tract. government site. Diagnostic cholangiogram is performed (47531), demonstrating a distal common bile duct stenosis. Abdominal drains prolonged the duration of the surgical procedure (MD: 5.69 min; 95% CI: 2.51-8.87; . 0000266995 00000 n Other Policies and Guidelines may apply. 0000264720 00000 n You must log in or register to reply here. Although the wRVUs for 47562 and 47563 do not reflect the RUC review of survey data and RUC recommendation, their work RVUs are correctly ranked. government site. 2020 Dec;29(6):150998. doi: 10.1016/j.sempedsurg.2020.150998. 0000264401 00000 n Just as catheter drainage of acute infection with interval appendectomy is accepted in patients with periappendiceal abscess, tube cholecystostomy with interval laparoscopic cholecystectomy has a role in the management of select patients with acute cholecystitis.6 These patients can be then sent home on a course of antibiotics to help them recover from the acute illness. Drainage is coded for both diagnostic and therapeutic drainage procedures. Earn CEUs and the respect of your peers. Next we discuss outpatient management of cholecystostomy tubes and an algorithm for tube . 0000204971 00000 n Forty-four patients had the PCT removed and were managed non-operatively (30.1%) of which 5 developed recurrent . This technique is also favorable from a cosmetic viewpoint because the resultant wound can be reused as the trocar insertion site at the time of laparoscopic cyst excision.8. 47538 describes the placement of a completely internal stent (metallic or plastic) via an existing access (prior external biliary catheter or internal/external biliary catheter access) and includes exchange of an existing externally draining biliary catheter (if done); down-conversion to an external catheter (when the original catheter is an internal/external catheter); or removal of a catheter at the end of the procedure. Percutaneous Aspiration Of Gallbladder. He was therefore taken to the operating room for planned laparoscopic cholecystectomy, after his acute medical condition was stabilized. Laparoscopic cholecystectomy procedures without common bile duct exploration (CBDE) typically map to MS-DRGs 417-419. . At that time the RUC recommended a wRVU of 12.11 for CPT code 47563, however, CMS reduced the value to 11.47. 0000266359 00000 n 1989 Dec;21 Suppl 1:373-4 These abnormalities can occur anywhere in the collecting system, but most often are between the ampullary sphincter of the distal common bile duct and the bifurcation of the more proximal common bile duct. Based on a work at https://medcraveonline.com Contact Us, 2014-2023 MedCrave Group. Percutaneous placement of cholecystostomy drain has been used in critically ill patients suffering from sepsis from acute cholecystitis, and patients with significant comorbidities who would not tolerate a prolonged procedure. Unauthorized use of these marks is strictly prohibited. Acute cholecystitis tends to be one of the highest risks for conversion to open surgery-due to unclear anatomy, excessive bleeding or technical complications.2,3, The use of percutaneous cholecystostomy tube placement by IR has been well accepted as a temporizing measure in patients with acute cholecystitis who are too unstable to undergo laparoscopic cholecystectomy. 0000265938 00000 n Do not submit 47533 or 47534 with this procedure. 0000010623 00000 n 2012 ICD-9-CM Procedure Code 51.01. Example: A patient has an existing external biliary drainage catheter. Accessibility Could you recommend a resource that would help me with gastrostomy (NG, JG, NJ, etc) diagnosis coding? Next month, well cover CPT updates for percutaneous neurologic intervention. Timing of percutaneous cholecystostomy affects conversion rate of delayed laparoscopic cholecystectomy for severe acute cholecystitis. Gadacz TR, Crist DW. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Laparoscopic tube cholecystostomy remains an alternative to open surgery in cases where the gallbladder is judged too . ;Gm About 6 weeks later, the patient underwent laparoscopic cholecystectomy, with removal of cholecystostomy tube- uneventfully. For percutaneous G-tube replacement under endoscopic guidance, report instead 43246Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube. Designed by Elegant Themes | Powered by WordPress. Would you like email updates of new search results? Affiliation 1 Department of Surgery, Section of . However, for 2013, CMS did not agree with the RUC and instead further reduced the wRVU for 47562 to correct the rank order anomaly that CMS created when it reduced the wRVU for 47563. Epub 2015 Jul 3. 0000310963 00000 n Readmission rates range from 0-8%; common causes for readmission after same day discharge include pain, intra-abdominal fluid collections, bile leaks, and bile duct stones (Sherigar, et al. Uchiyama K, Tani M, Kawai M, et al. Percutaneous cholecystostomy, which includes placement of a drainage catheter into the gallbladder (47490 Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation), remains unchanged in 2016. The codes differentiate existing access from new access: For a better experience, please enable JavaScript in your browser before proceeding. The radiologist will create a new access into a bile duct and advance a wire and small catheter across the biliary system and ampulla into the small intestine. A new internal/external stent is placed over the wire (exchange of biliary drainage catheter, 47536). 47540 new access, with placement of separate biliary drainage catheter (eg, external or internal-external) 0000010319 00000 n Use of modifier 22 is not appropriate if the sole use of the modifier . Repair of Right Hepatic Duct Injury. The CPT code for removal of a gastrostomy tube is 43999. 47539 new access, without placement of separate biliary drainage catheter Cholecystostomy is the procedure of putting a tube in gall bladder. PMC Since the development of this procedure, multiple alternatives have been developed, including the Chait cecostomy tube. 0000013436 00000 n MOJ Clin Med Case Rep. 2020;10(3):7072. 0000196901 00000 n The https:// ensures that you are connecting to the 0000278194 00000 n Right hip pain ICD 10 coding is made easier with our billing guidelines. Epub 2020 Nov 20. 2020;10(3):70-72. A(/u4CL/|$^7hME6PZ.Y.1 IVG5f)t\a]kx@@z[7"h4/Z,By Required fields are marked *. There is no imaging guidance, it technically is not done "percutaneously" although a "new incision" was created but I don't think that counts. If the radiologist leaves in a drainage catheter, 47533 or 47534 should be submitted instead of 47541. It was therefore difficult to dissect the anatomical structures. #2. if you have Dr. Z's interventional book, it tells you to use abcess codes 49424,76080,49423 & 75984 for tube check and change of cholecystostomy tube if the the tube was originally placed for infection drainage. 0000232952 00000 n Example: The patient recently underwent external biliary drainage catheter placement for biliary obstruction and infection. Laparoscopic cholecystectomy can be quite challenging in especially in certain situations. 0000267926 00000 n Cholangioplasty at the site of a stent placement during the same session is bundled and not separately coded. J Laparoendosc Adv Surg Tech A. Diagnostic cholangiography Best answers. 0000210646 00000 n CPT Code For Laparoscopic Cholecystectomy With Removal Of Cholecystostomy Tube Cholecystostomy is the procedure of putting a tube in gall bladder. 0000010737 00000 n 0000312225 00000 n The procedure of gall bladder removal and Cholecystostomy removal can be performed side by side with the help of laparoscope computer imaging. H\0s^[[ Please enable it to take advantage of the complete set of features! The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Gurusamy KS, Koti R, Davidson BR. CCY cholecystectomy, CCYT-tube cholecystostomy-tube from publication: Percutaneous cholecystostomy-tube for high-risk patients with acute cholecystitis: current practice and implications for . As well, all of the new codes bundle the use of imaging guidance, including fluoroscopy, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI).