Health Information Management

Q&A: Percutaneous vs. trocar cholecystostomies

HIM-HIPAA Insider, April 19, 2011

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Q: The following procedures are performed in the radiology department:

  • 51.01 (percutaneous cholecystostomy for drainage)
  • 51.02 (trocar cholecystostomy)
Code 51.01 has no effect on the DRG. However, code 51.02 generates a surgical DRG. How do these procedures differ clinically? 
A: You are correct. A percutaneous cholecystostomy often is performed in the interventional laboratory. However, a true trocar cholecystostomy is performed in the operating room under laparoscopic guidance. A surgeon may perform this procedure when a patient has a severely distended gallbladder and is too ill to withstand a formal open cholecystectomy. The surgeon inserts a trocar into the gallbladder to permit drainage of a blocked biliary system, thus preventing ascending cholangitis and fatal infection by removing bile, pus, and stones. However, this procedure requires visual guidance with a laparascope. Surgeons also may perform it during an open exploration.
Editor’s note: Robert S. Gold, MD, CEO of DCBA, Inc., in Atlanta answered this question in the April issue of Briefings on Coding Compliance Strategies.

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