CPT CODE 49082 - Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance -Average fee amount $200
CPT CODE 49083 - Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance -Average fee amount $280 - $320
CPT 49084 Peritoneal lavage, including imaging guidance, when performed
New/Deleted CPT Codes for Abdominal Paracentesis and Peritoneal Lavage
For 2012, three new CPT codes for abdominal paracentesis and peritoneal lavage have been created. These replace codes 49080 and 49081, abdominal paracentesis, initial and subsequent procedures, respectively.
The new codes for abdominal paracentesis, 49082 and 49083, describe the procedure performed without or with imaging guidance. If the health-care professional performs abdominal paracentesis without imaging guidance, code 49082, Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance. If abdominal paracentesis is performed with imaging guidance (regardless of the method used), code 49083, Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance.
Code 49084, Peritoneal lavage, including imaging guidance, when performed is used to describe the procedure where a vertical skin incision is made, the linea alba is divided and the peritoneum entered after it has been picked up to prevent bowel perforation. A catheter is inserted towards the pelvis and aspiration of material is attempted using a syringe. If no blood is aspirated, warm saline is infused and after a few minutes, the effluent is drained and sent for analysis.
Parentheticals are included with codes 49083 and 49084 instructing the provider not to report these codes with separate imaging codes, including ultrasonic guidance code 76942, fluoroscopic guidance code 77002, computed tomography guidance code 77012, and/or magnetic resonance guidance code 77021.
Misuse of column two code with column one code
For example, CPT code 49322 describes a surgical laparoscopy with aspiration of single or multiple cavities or cysts (eg, ovarian cyst). CPT code 49082 describes an abdominal paracentesis (diagnostic or therapeutic) without imaging guidance. It is a misuse of CPT code 49082 to report it in addition to CPT code 49322 at the same patient encounter since the procedure described by CPT code 49322 includes the procedure described by CPT code 49082.
Medicaid - Maximum fee pricing assigned to CPT code 49083
Effective November 1, 2013, the Indiana Health Coverage Programs (IHCP) has assigned maximum fee pricing to Current Procedural Terminology (CPT) code 49083 – Abdominal paracentesis (diagnostic or therapeutic) with imaging guidance. The maximum fee for CPT code 49083 is $412.39. For dates of service on or after November 1, 2013, the IHCP will reim- burse providers billing claims for CPT code 49083 as an outpatient service.
The AMA added three new codes in the digestive system subsection, including two for abdominal paracentesis (diagnostic or therapeutic):
* 49082: Without imaging guidance
* 49083: With imaging guidance
Coders should report the third new code, 49084, to denote peritoneal lavage, including imaging guidance, when performed. This is an open procedure that physicians typically perform on acute unstable patients. Physicians use it to assess a patient’s blood for enteric contents and for additional laboratory analysis, Sarasin says.
Remember that aspiration involves removal of the catheter or needle at the conclusion of the procedure. Do not use codes 49082-49083 for drainage procedures in which a catheter is left indwelling.
Code 49083 includes imaging guidance, so guidance should not be reported separately.
In the case of ultrasound-guided paracentesis, code 49083 includes the limited ultrasound exam performed prior to paracentesis in order to determine the amount and location of the fluid. According to Clinical Examples in Radiology (Winter 2012), “This type of limited sonography is a necessary component of any ultrasound guidance procedure” and should not be coded separately.
If the preliminary ultrasound images do not show any fluid, paracentesis will not be performed. In this situation it is appropriate to report a limited ultrasound exam of the abdomen (76705) for the preliminary imaging.
Authorization requirments
Almost all the insurance require prior authorization for these procedure so get it before rendering the service.
Paracentesis
Paracentesis is the aspiration of fluid from the abdominal cavity. It is most often performed for ascites, which is an abnormal accumulation of peritoneal fluid caused by liver disease, cancer or other conditions. Paracentesis may be performed for diagnostic purposes, in which case only a small amount of fluid is removed. Alternatively, large volume paracentesis (removal of up to 6 liters of fluid) may be performed for therapeutic purposes. Following large volume paracentesis the patient may receive an albumin infusion to prevent electrolyte imbalance.
The following codes are used to report paracentesis:
CPT Code Description
49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance
49083 . . . with imaging guidance Remember that aspiration involves removal of the catheter or needle at the conclusion of the procedure. Do not use codes 49082-49083 for drainage procedures in which a catheter is left indwelling.
Code 49083 includes imaging guidance, and ultrasound is the most common guidance modality. Code 49083 includes the limited ultrasound exam performed prior to paracentesis in order to determine the amount and location of the fluid. According to Clinical Examples in Radiology (Winter 2012), “This type of limited sonography is a necessary component of any ultrasound guidance procedure” and should not be coded separately. If the preliminary ultrasound images do not show any fluid, paracentesis will not be performed. In this situation it is appropriate to report a limited ultrasound exam of the abdomen (76705) for the preliminary imaging. Ultrasound-guided paracentesis, like other ultrasound-guided procedures, requires permanently archived images. (See Clinical Examples in Radiology, March 2014.)
If the patient receives an albumin infusion following the paracentesis, Coding Clinic™ for HCPCS (Third Quarter 2013) states that the infusion is included in the paracentesis procedure. This guidance applies specifically to hospital billing for outpatient services.
EXAMPLE: A patient with ascites undergoes aspiration of peritoneal fluid under ultrasound guidance for cytologic examination.
CODE: 49083
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