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-   -   Psoas Muscle Abscess Drainage (http://www.aapc.com/memberarea/forums/showthread.php?t=23817)

drobinson1 09-24-2009 01:21 PM

Psoas Muscle Abscess Drainage
 
I don't how to code this drainage. I was thinking 20000 and 77012 but I am not sure:

Clinical History: Abnormal collection within the right psoas muscle

Patient was placed on the CT examination table in prone position. Monitored conscious sedation was administered for 30 minutes. Localization imaging was performed. Right psoas collection was identified. Skin overlying the right flank was prepped and draped in a sterile fashion. Following local anesthesia, the sheath needle was advanced into the right psoas collection under CT guidance. Aspiration recovered frankly pearl and fluid. Specimens were sent for microbiologic analysis. The sheath needle was exchanged out over a guidewire and the entry site dilated for placement of an 8 French locking loop all-purpose drainage catheter. Drainage catheter positioning within the collection was confirmed with repeat CT imaging. The catheter was placed external gravity drainage and secured at the skin with an adhesive device. Sterile dressings were applied. Patient tolerated the procedure well. No complication was encountered.


IMPRESSION:
8 French APDL drain placed for evacuation of a right psoas abscess under CT guidance.

prabha 09-25-2009 03:17 AM

I think 49061 & 75989-26 would be appropriate as psoas abscess(567.31)is listed under retroperitoneal infections in the dx listing

dpeoples 09-25-2009 08:50 AM

Quote:

Originally Posted by prabha (Post 74897)
I think 49061 & 75989-26 would be appropriate as psoas abscess(567.31)is listed under retroperitoneal infections in the dx listing

I concur.

HTH :)

msncoder 09-25-2009 09:09 AM

The reason for the exam was for a psoas MUSCLE abscess which would be coded as 75989 & 20000. The report does not state that the cath was placed within the retropertioneal cavity nor does it support a retroperitoneal infection so I disagree with coding 75989 & 49061

dpeoples 09-25-2009 09:35 AM

Quote:

Originally Posted by msncoder (Post 74958)
The reason for the exam was for a psoas MUSCLE abscess which would be coded as 75989 & 20000. The report does not state that the cath was placed within the retropertioneal cavity nor does it support a retroperitoneal infection so I disagree with coding 75989 & 49061

That is a reasonable arguement for 2000/75898. However, the description for 2000 is for an "incision of the soft tissue abscess: superficial". The psoas muscle is a deep tissue muscle, so 2005 would be more accurate. However, this was not done by incision, but percutaneously with a catheter placed for drainage so IMO the 2000 series codes do not apply.

A reasonable alternative to this scenario is 10160/75898 but it all depends on the dept of the abscess, that is why I usually use 49061/75989.

I am curious as to why you feel the psoas muscle abscess is not a retroperitoneal infection?

:)

msncoder 09-29-2009 01:14 PM

My apologies for the delayed response, I tend to forget to check back in to see if there has been a reply!

I do not disagree that a psoas muscle abscess is in the retro area and could be considered as a retroperitoneal abscess however when choosing a CPT we are instructed to choose the CPT that accurately describes the procedure performed and not one that "resembles" it or one that somewhat describes the procedure. If you choose CPT 49061 then you are stating that a drainage was performed within the retroperitoneal cavity which was not documented nor supported in the report.

I will attempt to locate the ACR article that references this exact scenario in which they instruct coders to use CPT 20000. In the report it mentions that the SHEATH needle was replaced and the area was dilated therefore ACR feels that it would fall into the "incision & drainage" category. I will provide the link to this article/reference as soon as I return to my office this week.


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