If your surgeon inserts a tunneled intraperitoneal catheter with a subcutaneous port, you should report 49419 instead of one of the other codes. Look for terms such as "totally implantable" to describe the type of catheter that involves a port. You're likely to see this sort of procedure for administration of chemotherapeutic agents.
Gain removal pay: CPT also provides a code for times when your surgeon removes a tunneled intraperitoneal catheter -- 49422. Don't use this code for removing a non-tunneled catheter -- use an appropriate E/M code instead, according to CPT instruction.
"If the surgeon replaces an existing tunneled catheter, you should not report 49422 in addition to the insertion code," Bucknam says. "Report only the insertion code when the surgeon removes a tunneled catheter at the same operative session as placing a new one."
4. Don't Unbundle Image Guidance
Based on the code definitions, new codes 49412 and 49418 include image guidance, if performed. The restriction in the definition correlates to CCI edits that bundle the codes with imaging guidance by the following methods:
fluoroscopy (such as 76000, Fluoroscopy[separate procedure], up to 1 hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy])
ultrasound (such as 76942, Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation)
computed tomography (such as 77012, Computed tomography guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], radiologic supervision and interpretation)
magnetic resonance (such as 77021, Magnetic resonance guidance for needle placement[e.g., for biopsy, needle aspiration, injection or placement of localization device], radiologic supervision and interpretation).
Although revised code 49324 doesn't specifically state that it includes imaging guidance, CCI includes similar edit pairs that bundle imaging guidance with the laparoscopic catheter insertion code.
5. Use Different Codes for Drainage
Deleted code 49420 provided a way for you to report insertion of a temporary catheter for drainage. Now that the remaining intraperitoneal catheter insertion codes describe tunneled catheters for chemotherapy or dialysis, how should you report drainage?
Do this: A CPT text note following 49419 instructs, "To report open or percutaneous peritoneal drainage, see 49060, 49061, 49062, 49080, 49081, as appropriate."