Gastroenterology Coding Alert

Question: I have a report for a paracentesis procedure performed on a 58-year-old patient. The patient has decompensated cirrhosis and presented with increasing abdominal distention, early satiety, and shortness of breath. The gastroenterologist performed diagnostic and therapeutic paracentesis with ultrasound guidance. Approximately 4 liters of ascitic fluid were removed and sent for laboratory analysis. The documentation clearly distinguishes imaging guidance from the fluid drainage procedure.

Can we report the guidance separately from the paracentesis?

West Virginia Subscriber

Answer: You cannot report the ultrasound guidance separately from the paracentesis procedure because the imaging guidance is inherently included in the paracentesis. Code 49083 (Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance) includes “with imaging guidance” in the descriptor. At the same time, the code features a parenthetical note instructing you to not report 49083 with the following imaging guidance codes:

• 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) (List separately in addition to code for primary procedure))
• 77012 (Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation)
• 77021 (Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation).

Mike Shaughnessy, BA, CPC, Production Editor, AAPC