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10160 vs 49406

  1. Post 10160 vs 49406
    Medical Coding Books
    Hello All,
    hoping someone can assist i have IR providers who do a drainage via YUEH catheter of peritoneal abscess but they remove the catheter following the procedure so normally this would be coded to 10160 but for CMS Medicare they are denying this because of the LCD in place- the dx does not meet medical necessity.
    what are we supposed to do the diagnosis code is the appropriate diagnosis code and i thought that 49406 couldnt be used if the catheter is removed.


    thank you,

  2. #2
    Default
    Quote Originally Posted by CoderNicole View Post
    Hello All,
    hoping someone can assist i have IR providers who do a drainage via YUEH catheter of peritoneal abscess but they remove the catheter following the procedure so normally this would be coded to 10160 but for CMS Medicare they are denying this because of the LCD in place- the dx does not meet medical necessity.
    what are we supposed to do the diagnosis code is the appropriate diagnosis code and i thought that 49406 couldnt be used if the catheter is removed.


    thank you,
    You are correct CPT 49406 cannot be billed if the catheter is removed at the end of the procedure. The correct CPT is 10160 and the guidance used (E.g. 76942, 77012). If you are referring to LCD L28490 They do include post procedural complication codes. Are those an option you can use in this scenario?

  3. Question
    in some cases the postprocedural icd-10 is applicable but not many. i just find it kind of strange that they would create the lcd but not include diagnosis codes that would be related but somehow do have the postprocedural one

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