Wiki 49083 -paracentesis coding

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We are getting dinged by an outside auditor for our paracentesis coding regarding guidance. Auditor states the guidance must document the actual needle placement and doesn't feel the "ultrasound guided...paracentesis" is enough. This is a sample report:

The patient was placed supine on the ultrasound table and a preliminary ultrasound performed of the right lower quadrant. The deepest pocket of fluid was localized and the skin was then marked, prepped, and draped in normal sterile fashion. 2% Lidocaine was used for local skin anesthesia. A skin incision was made and an 8-French catheter was inserted into the peritoneal cavity and approximately 1560 ml of yellow fluid was aspirated. The catheter was removed and a dressing was placed at the entry site. The patient tolerated the procedure well. Final imaging demonstrated no residual ascitic fluid in the peritoneal cavity.
IMPRESSION: Successful ultrasound guided right lower quadrant paracentesis using a catheter.

The radiologists we have tried to convey this "rule" to think we are nuts.... Thoughts? Any documentation out there to back this up for my docs?

Thanks!
 
Here is what our doctors dictate for the paracentesis...."Under ultrasound guidance a 5 French Yueh catheter was inserted into the abdomen and 2950 ml of serosanguineous fluid was obtained." Not sure if this will help???/
 
Your documentation looks good, the guidance was used for cath placement, no issues there. I'm just wondering if anyone else has had auditors flag the 49083 because, like the documentation I posted, it does not specifically state ultrasound was used to actually guide the needle.
 
We submitted this question to Dr. Z and he says while the documentation is not ideal, he would code it the 49083 with the information in the body of the report and the impression does mention "ultrasound guided paracentesis."

I was almost hoping he would agree with our auditor but this is good information to support our case.
 
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