Re "Ask Caryl" (September, page 30). The table of ASC Medicare-approved laparoscopy procedures lists CPT 47560 (laparoscopy with cholangiography) and CPT 47561 (laparoscopy with cholangiography and biopsy). The listing of these two procedures as approved and cholecystectomy's not being approved mystifies me. As a practicing surgeon for 35 years, it would be very uncommon for an individual to do a laparoscopy and cholangiography unless he were to perform a cholecystectomy at the same time. If Medicare approves cholangiography with laparoscopy, it would seem strange that it does not permit laparoscopic cholecystectomy. When you perform a cholangiography, usually you will use the cystic duct and occlude the distal cystic duct to insert the catheter.

Raymond Dieter, MD
The Center for Surgery
Naperville, Ill.