CPT® 2014 Groups Drainage Codes with S&I
Familiarize yourself with new image-guided percutaneous fluid collection drainage codes, understand the rules, and apply them to scenarios.
By Terri Brame, MBA, CHC, CPC, CPC-H, CPC-I, CGSC
A review led by the American Medical Association’s CPT® Editorial Panel last year showed that codes for the surgical portion of percutaneous fluid drainage procedures were being reported with the codes for imaging supervision and interpretation (S&I) more than 75 percent of the time. Based on this review, the consensus reached was that a single code representing both services may be more appropriate. As a result, CPT® 2014 brings major changes for reporting percutaneous fluid drainage by catheter.
Many Changes to 2014 Coding
Several drainage codes were deleted for CPT®2014 and replaced by only a handful of new, more inclusive codes.
Deleted CPT® codes, effective Jan. 1, 2014:
Pneumonostomy; with percutaneous drainage of abscess or cyst
Incision and drainage of appendiceal abscess; percutaneous
Hepatotomy; for percutaneous drainage of abscess or cyst, 1 or 2 stages
External drainage, pseudocyst of pancreas; percutaneous
Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; percutaneous
Drainage of subdiaphragmatic or subphrenic abscess; percutaneous
Drainage of retroperitoneal abscess; percutaneous
Drainage of perirenal or renal abscess; percutaneous
Drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous (eg, ovarian, pericolic)
New codes were created specifically to describe draining fluid collections by catheter, defined within the code descriptors as an abscess, hematoma, seroma, lymphocele, cyst, or other similar contained fluid collection.
New CPT® codes, effective Jan. 1, 2014:
10030 Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck), percutaneous
49405 Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous
49406 peritoneal or retroperitoneal, percutaneous
49407 peritoneal or retroperitoneal, transvaginal or transrectal
Percutaneous fluid drainage involves inserting a large bore needle or catheter into fluid collection to drain that fluid. The device is often left in place to allow continuous fluid drainage, as needed. Because the procedure is performed without an open approach, many physicians use imaging—including fluoroscopy, ultrasound, computed tomography (CT), or magnetic resonance imagery (MRI)—to guide the needle insertion and confirm the needle accesses the fluid. S&I of the imaging is always included.
Never report the following radiologic S&I CPT® codes with percutaneous image-guided fluid collection drainage codes:
75989 Radiologic guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid)
77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
77021 Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation
Percutaneous image-guided fluid collection drainage codes may be reported once for each fluid collection drained, but may not be reported more than once per fluid collection, regardless of the number of times the fluid collection is accessed.
Clinical Scenario 1
Indications: A 67-year-old patient presents with fever and left, upper-quadrant pain increasing over the past 36 hours. The pain is not associated with eating a meal or other event. Patient has known cirrhosis secondary to alcoholism. CT indicates a right hepatic abscess.
Procedure: The physician identifies the right hepatic lobe abscess using imaging guidance. The abscess is accessed using a guidewire. The physician aspirates purulent material, which is sent for culture. The access point is dilated to allow placement of a drainage catheter, which is sutured in place without complication.
Clinical Scenario 2
Indications: A pediatric patient with a history of chronic throat infections presents with continued swelling and pain in the neck, not associated with a current infection. The physician suspects retropharyngeal abscess secondary to lymph node breakdown, versus cellulitis. CT confirms there is an abscess.
Procedure: Using CT imaging, the physician identifies the retropharyngeal abscess and enters the fluid collection with a guidewire. Purulent material is aspirated and sent for culture. The access point is dilated to allow placement of a drainage catheter, which is sutured in place without complication. The patient is kept inpatient until the drain can be removed.
New Codes Apply to Percutaneous Drainage, Only
The new codes only apply to percutaneous drainage by catheter and certain transvaginal and transrectal drainages. Many new parenthetical instructions have been added to CPT® to redirect you to other drainage codes. In all, CPT® added or revised 30 parenthetical notes regarding correct coding for fluid drainage. For example, following 49407, parenthetical notes direct the coder to thoracentesis, percutaneous pleural drainage, open drainage, and peritoneal drainage codes.
CPT® retains existing codes to report specific percutaneous procedures. For example, percutaneous cholecystostomy (creating a surgical opening in the gallbladder using a percutaneous approach) is still reported using 47490 Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation; and cavity drainage is still reported with codes for thoracentesis (32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance, 32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance) and abdominal paracentesis (49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance, 49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance).
Terri Brame, MBA, CHC, CPC, CPC-H, CPC-I, CGSC, is the compliance education officer for the University of Arkansas for Medical Sciences. She is also the author of E&M Coding Clear & Simple, Evaluation & Management Coding Worktext, published by F.A. Davis, the Taber’s Cyclopedic Medical Dictionary publisher. Brame is a member of the Little Rock Central, Ark., local chapter, and a past local chapter president.