Liver Abscess Drain Check/Drain Removal

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Hi,

We are having a confusion about this. My co-auditor would code 47537 for the removal of liver drain. I would code just 49424 for the abscess drain check because removal of liver drain is E/M code as per our Encoder. Any thoughts? Thank you so much :)


Reason For Exam
LIVER ABSCESS DRAIN CHECK;Abscess

IR Fistula Sinus Tract
IR Fistula Sinus Tract

PREOPERATIVE DIAGNOSIS: 64-year-old male with history of liver abscess x2 status post percutaneous drainage. He has less than 5 cc of drainage per catheter per day.

POSTOPERATIVE DIAGNOSIS: Same

COMPARISON: Prior tube check from June 29, 2016

OPERATOR:

PROCEDURE:
Liver abscess drain check and removal x2

TECHNIQUE: Following informed consent the patient was brought to interventional radiology and placed in a supine position. Both liver abscess drains were prepped and draped in usual sterile fashion. Contrast was injected through each drain and spot fluoroscopic images were obtained. Each drain was then cut and removed over wire.

FINDINGS: No significant residual abscess cavity.

FLUOROSCOPY TIME: 0.9 minutes

CONTRAST DOSE: 10 cc Omnipaque 300

ANESTHESIA: None

COMPLICATIONS: None.

SPECIMEN: None.

ESTIMATED BLOOD LOSS: None.

PATIENT STATUS: Stable.

IMPRESSION:

NO SIGNIFICANT RESIDUAL HEPATIC ABSCESS CAVITY. THEREFORE, BOTH DRAINS WERE CUT AND REMOVED.
 
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Is this falling into a global period? If so, that might be why the Encoder is pointing you towards an E/M code instead of coding for the removal....?
 

kmgauthier

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Holly Ridge, NC
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Hi,

We are having a confusion about this. My co-auditor would code 47537 for the removal of liver drain. I would code just 49424 for the abscess drain check because removal of liver drain is E/M code as per our Encoder. Any thoughts? Thank you so much :)


Reason For Exam
LIVER ABSCESS DRAIN CHECK;Abscess

IR Fistula Sinus Tract
IR Fistula Sinus Tract

PREOPERATIVE DIAGNOSIS: 64-year-old male with history of liver abscess x2 status post percutaneous drainage. He has less than 5 cc of drainage per catheter per day.

POSTOPERATIVE DIAGNOSIS: Same

COMPARISON: Prior tube check from June 29, 2016

OPERATOR:

PROCEDURE:
Liver abscess drain check and removal x2

TECHNIQUE: Following informed consent the patient was brought to interventional radiology and placed in a supine position. Both liver abscess drains were prepped and draped in usual sterile fashion. Contrast was injected through each drain and spot fluoroscopic images were obtained. Each drain was then cut and removed over wire.

FINDINGS: No significant residual abscess cavity.

FLUOROSCOPY TIME: 0.9 minutes

CONTRAST DOSE: 10 cc Omnipaque 300

ANESTHESIA: None

COMPLICATIONS: None.

SPECIMEN: None.

ESTIMATED BLOOD LOSS: None.

PATIENT STATUS: Stable.

IMPRESSION:

NO SIGNIFICANT RESIDUAL HEPATIC ABSCESS CAVITY. THEREFORE, BOTH DRAINS WERE CUT AND REMOVED.

I believe you are correct in only billing for the abscess drain check. If it were a tunneled drainage catheter you could bill the removal code, however, for the removal of a nun-tunneled catheter you should bill an E/M code. That wouldn't be applicable in this situation since the reason for the visit was the abscess drain check.

Thanks,

Krystal Gauthier, CCS-P, CIRCC
 
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The appropriate coding is 49424 (Contrast injection for assessment of abscess or cyst via previously placed drainage catheter or tube) and 76080 (Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation).

The removal is included within the primary procedure (49424 & 76080) performed on the day of the removal.

Code low level E&M for removal of an abscess or other non-tunneled drainage catheter as appropriate. Do not code 49422 for removal of an abscess catheter.



Christina Neighbors, MA CPC CCC
 
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