General Surgery Coding Alert

Use different codes for visceral, peritoneal, other sites.

With four new and two deleted fluid collection codes in CPT® 2014, you’ll need to rethink how you report certain catheter-drainage procedures that your surgeon performs this year.

The new codes are specific to anatomic site and include image-guidance. The following synopsis will give you the low-down on everything you need to know to use the codes and capture the pay you deserve in this new year.

Capture Integumentary Service

You’ll find a whole new subsection under the Integumentary System heading “Skin, Subcutaneous, and Accessory Structures” in CPT® 2014: “Introduction and Removal.”

Just one new code occupies the subsection, and you’ll use that code to report drainage of certain fluid collections for percutaneous soft tissue. The code is 10030 (Image-guided fluid collection drainage by catheter [e.g., abscess, hematoma, seroma, lymphocele, cyst], soft tissue [e.g., extremity, abdominal wall, neck], percutaneous).

The unit of service for the code is “each individual collection drained with a separate catheter,” so your surgeon could charge multiple units of 10030 on a single date, when appropriate.

Included: Because the code describes “image-guided” placement, the radiological supervision and interpretation (S&I) is included in the procedure. That’s affirmed by a new text note instructing you not to report 10030 with 75989, 76942, 77002, 77003, 77012, or 77021.

Bundling S&I into new codes seems to be in keeping with the recent AMA trend, notes Marchelle Cagle, CPC, CPC-I, CMOM, of Alabama-based Cagle Medical Consulting.

Don’t get confused: CPT® provides a multitude of existing codes for similar procedures that have a more specific method and/or purpose. Instead of 10030, make sure you continue to use separate codes for these procedures, such as placement of percutaneous localization devices, needle biopsies, fine needle aspirations, and breast biopsies with imaging, according to Albert Bothe Jr., MD, FACS, AMA CPT® editorial panel member, in his presentation at the CPT® and RBRVS 2014 Annual Symposium.

Also, CPT® 2014 adds a text note to make sure you don’t confuse 10030 with other codes for image-guided fluid collection drainage of visceral, peritoneal or retroperitoneal sites. The note directs you to the three new abdominal codes, which you can read about in the next section.

Greet 3 New Abdominal Codes

You’ll find the following three new codes in the Abdomen, Peritoneum, and Omentum Surgery section:

• 49405 — Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); visceral (e.g., kidney, liver, spleen, lung/mediastinum), percutaneous
  
• 49406 — … peritoneal or retroperitoneal, percutaneous
  
• 49407 — … peritoneal or retroperitoneal, transvaginal or transrectal.
  

Select one of these codes instead of 10030 for image-guided fluid collection drainage by catheter at visceral, peritoneal, or retroperitoneal sites.

Check methodology: For peritoneal or retroperitoneal locations, you should select 49406 or 49407 based on the surgical approach — percutaneous or transvaginal/transrectal.

Included: As with 10030, these codes describe “image-guided” placement and include the radiology S&I. That’s why CPT® 2014 adds text notes instructing you not to report 49405-49407 with 75989, 76942, 77002, 77003, 77012, or 77021.

Don’t get confused: Many CPT® codes describe services similar to those represented by 49405-49407, and CPT® 2014 adds text notes to ensure that you choose one of those codes when it’s more appropriate. In addition to a note directing you to 10300 when it’s a more suitable choice, here’s a line-up of the other procedures/codes identified in the notes:

• For percutaneous cholecystostomy, use 47490
• For pneumonostomy, use 32200
• For thoracentesis, see 32554, 32555
• For [percutaneous] pleural drainage, see 32556, 32557
• For open drainage, see 32220, 47010, 48510; 44900, 49020, 49040, 49060, 50020, 58805, 58822; 45000, 58800, 58820
•  
• For abdominal paracentesis (diagnostic or therapeutic), see 49082, 49083
• For peritoneal lavage or paracentesis, see 49082, 49083, 49084
• For percutaneous insertion of a tunneled intraperitoneal catheter without subcutaneous port, use 49418
• For open or percutaneous peritoneal drainage or lavage, see 49020, 49040, 49082 as appropriate.

Delete These Codes

With the addition of 49405-49407, CPT® 2014 deletes codes, such as the following, that described similar services but didn’t include imaging:

• 32201 — Pneumonostomy; with percutaneous drainage of abscess or cyst
  
• 48511 — External drainage, pseudocyst of pancreas; percutaneous
  
• 49021 — Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; percutaneous
  
• 49041 — Drainage of subdiaphragmatic or subphrenic abscess; percutaneous
  
• 49061 — Drainage of retroperitoneal abscess; percutaneous
  
• 50021 — Drainage of perirenal or renal abscess; percutaneous
  
• 58823 — Drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous (e.g., ovarian, pericolic).
  

New text notes inform you of the deletions and direct you to the appropriate new code.