Procedure Code Changes and Description
• Deleted Codes
* 49080 - Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial
* 49081 - Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); subsequent
• New Codes
* 49082 – Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance
* 49083 - with imaging guidance
* 49084 – Peritoneal lavage, including imaging guidance, when performed
• (Do not report 49083 or 49084 in conjunction with 76942, 77002, 77012, 77021)
Example
Diagnosis: Malignant ascites
Procedure: Therapeutic paracentesis
The patient is explained the risks, benefits, and alternatives of the procedure abdominal paracentesis for treatment of her malignant ascites. She fully understood and wished to proceed. Pre-operative sonographic images of the abdomen show a large volume of ascites with a pocket free of bowel loops with the left lower quadrant, this will be our entry point. The overlying skin was prepped and draped 2% lidocaine was utilized for local anesthetic. A 7- french sheath needle was passed via a left lower quadrant approach into the ascitic fluid. Clear, straw-colored ascitic fluid was noted. A total of 7 liters was removed. The sheath was removed; sampling was not taken to pathology. The patient tolerated the procedure well with no apparent complications.
• Correct CPT code: 49082
CPT® Procedure Code Changes
• Revised Parenthetical notes
* 49418 - Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous
* 49419 - Insertion of tunneled intraperitoneal catheter, with subcutaneous port (i.e., totally implantable)
(49420 has been deleted. To report open placement of a tunneled intraperitoneal catheter for dialysis, use 49421. To report open or percutaneous peritoneal drainage or lavage, see 49020, 49021, 49040, 49041, 49082-49084, as appropriate. To report percutaneous insertion of a tunneled intraperitoneal catheter without subcutaneous port, use 49418)
Paracentesis
*As stated in the ACR--SIR-SPR Practice Parameter for Specifications and Performance of Image-Guided Percutaneous Drainage/Aspiration of Abscesses and Fluid
Collections:
Image-guided percutaneous aspiration isdefinedas evacuation or diagnostic sampling of a fluidcollection using eithera catheter ora needle during a singleimagingsession, with removal of the catheter or needleimmediately after the aspiration.
Image-guided percutaneous drainage is defined as the placement of a catheter using
image guidance to provide continuous drainage of a fluid collection.
*Codes 49082 and 49083 describe a puncture of the abdominal cavity with insertion of a needle or catheter to remove fluid. The catheter/needle is removed at the end ofthe procedure.
* Code 49082 describes an abdominal paracentesis performed without imaging guidance.
* Code49083describes an abdominalparacentesisperformed withimagingguidance.
* Limited sonography for localization of fluid is bundled. If localization reveals no fluid,and the paracentesis is not performed assign code76705.
* For2018, theNCCIManualnotes the followingrevisedlanguage: “Evaluation of an anatomic region and guidance for a needle placement procedure in that anatomic region by the same radiologic modality on the same date of service may be reported separately if the two procedures are performed in different anatomic regions. For example, a physician may report a diagnostic ultrasound CPT code and CPT code 76942 (ultrasonic guidance for needle placement...) when performed in different anatomic regions on the same date of service. Physicians should not avoid these edits based on this principle by requiring patients to have the procedures performed on different dates of service if historically the evaluation of the anatomic region and guidance for needle biopsy procedures were performed on the same date of service.” -
Peritoneal Catheter Placements
• 49082 Paracentesis; Dx or Tx,w/o imagingguidance
• 49083 Paracentesis;Dx orTx, withimagingguidance
• If does paracentesis and leaves catheter inplace, use 49406 only.Do not code forthe paracentesis.
• If places indwelling catheter, sendsto floor for drainage,then pulls catheter onsame DOS, use49083
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.
Correspondence Language Policy/Example Number 14.40000 - 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
Guidelines from UHC insurance
The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. The listing of a code does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other Policies and Guidelines may apply
CPT Code Description
49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance