Sunday, September 4, 2016

CPT CODE 49082, 49083 - Abdominal paracentesis

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

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.

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