ED Coding and Reimbursement Alert

Question: Codes 49080* and 49420* seem to deal with the same procedure, and other than the amount of money reimbursed, I'm at a loss to know what indicators to use in charging the procedures. What is the difference between the two codes?

Gloria Peterson
Sheboygan Memorial Medical Center, Sheboygan, Wis.

Answer: There are several differences between the two codes. First, 49080* (peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; initial) is usually performed to drain fluid for treatment or evaluation (i.e., reducing a buildup of fluid or analyzing it for the presence of blood) and then the drain is removed. It is performed with a small tube or needle.

Code 49420* (insertion of intraperitoneal cannula or catheter for drainage or dialysis; temporary) represents a procedure that can be used, among other things, for lavage, but is usually placed with the expectation that the service will be used for a longer period of time (over a period of hours, days or longer). A cannula, which is a larger-diameter tube, is placed through an incision and remains to perform functions such as dialysis or drainage that require a longer period of time to be effective, usually due to continued buildup of fluid.