Wiki 2012 paracentesis coding question

[cedwards]

I'm billing for the gastroenterologist's professional service.

Would you use CPT code 49083 in this case?

I'm thinking no because the imaging was performed by the radiology tech and not my MD.

Operative report reads:

The patient was taken to the endoscopy suite where an informed consent was obtained. The patient was told of the risks of hemorrhage or perforation. He then underwent an abdominal ultrasound with an appropriate spot on the abdominal wall for paracentesis.

After a spot was chosen by the radiology technician, and area in the right lower quadrant was cleaned and prepped with alcohol and Betadine. The area was then infiltrated with novocaine. A small skin incision was made with an 11 blade, and a Barcelona needle was placed into the abdominal cavity. Straw-colored fluid returned. A total of 2300 ml were removed….

Thanks!
Christina

 

[koatsj]

I would bill 49083.

 

[JDV7980]

Christina, I would code 49083 also... the imaging is build into the code. Imaging guidance was still used!

Oh.... FYI- Medi-cal always takes some time to recognize new codes (usually about 6 months). If it is medi-cal and it getsdenied, appeal with the old paracentesis code 49080

 

[cedwards]

49083 denial

I am in Connecticut and billed the 49083 (abdominal paracentesis (diagnostic or therapeutic); with imaging to Medicaid-CT and they denied me for the following reasons...

4155 NO REIMBURSEMENT RULE FOR THE ASSOCIATED FACILITY TYPE

4250 NO REIMBURSEMENT RULE FOR THE ASSOCIATED PROVIDER TYPE/PROVIDER SPECIALTY

We are a gastroenterology practice, the operative clearly states The site for the paracentesis was determined by manual percussion and U/S guidance...

The 49083 is on our provider fee schedule as a payable code and from what I can tell there aren't any exclusions.

Any suggestions?