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What is the correct code for paracentesis via port?

Bonnie Posted Thu 20th of June, 2013 14:49:10 PM

Hi:

What would be the correct code for peritoneal fluid drainage via Bard Port using Bard Huber Needle?

Thank you

SuperCoder Answered Fri 21st of June, 2013 12:29:14 PM

For the percutaneous abscess drainage, you should report 49021 (Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; percutaneous).

The appropriate code for the guidance is 75989 (Radiologic guidance [i.e., fluoroscopy, ultrasound or computed tomography], for percutaneous drainage [e.g., abscess, specimen collection], with placement of catheter, radiologic supervision and interpretation).

"The surgeon inserts a needle through the abdominal wall and into an abscess pocket using radiological guidance to direct the placement of the needle. A pocket of infectious material is entered. A drain is placed into the pocket and as much material is drained as possible. Antibiotics are instilled into the area. The drain is left in place and sutured to the skin.
"

Bonnie Posted Tue 25th of June, 2013 18:59:42 PM

"Ultrasound guided peritoneal port insertion"
What if the patient has an ultrasound guided peritoneal port insertion and at same session fluid was removed. I am thinking that you would use two codes; one for port insertion and one for fluid removal. Can you please tell me which codes would be appropriate?
Thanks so much

SuperCoder Answered Thu 27th of June, 2013 01:27:17 AM

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."

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