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Peritoneal Drain Eval with Fluoro

  1. #1
    Default Peritoneal Drain Eval with Fluoro
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    Hi there-- How would you code the fluoroscopic evaluation of this peritoneal drainage catheter? I am not coming up with anything that feels right--maybe 49424?? or just 76000?? Otherwise All I can think of is the unlisted code 49999. So far I have 49080 for the drainage performed at the end of the procedure.

    HISTORY: 59-year-old with pain after placement of right lower
    quadrant abdominal/pelvic PleurX peritoneal drain.

    TECHNIQUE: The patient was brought to the interventional radiology
    department where there was a long discussion with myself, the patient,
    and his wife. They describe an episode of severe pain near completion
    of drainage several days prior. This pain terminated upon clamping the
    tube. Additional mild low level discomfort within the pelvis and
    within the tunneled tract in the right lower quadrant. There have been
    instances of drainage without discomfort or complication.

    Fluoroscopy was performed to demonstrate placement of the tube. A
    total of 25 mL Hexabrix contrast was administered into the peritoneal
    cavity without complication.

    Fluoroscopy time: 0.7 minutes.
    Sedation: None.
    Local anesthesia: None.

    COMPLICATIONS: None.

    FINDINGS: Spot fluoroscopic image overlying the pelvis demonstrates
    good position of the PleurX peritoneal drainage catheter. The position
    is relatively unchanged compared to previous exam. Contrast collects
    within the pelvic cavity.

    IMPRESSION:
    1. Good position of peritoneal drainage catheter with appropriate
    function. However, the patient describes several episodes of severe
    pain during drainage. Suspect this is due to suction being applied
    upon the bladder, and possibly surrounding loops of bowel. After
    lengthy discussion, it was decided to attempt gravity drainage and
    exclude any form of suction. While in the interventional department
    today, 300 mL of clear yellow fluid was drained without complication
    or discomfort.
    2. Persistent pain in the right lower quadrant when the patient lies
    in a right lateral decubitus position. Suspect this is due to the fact
    the tube was placed 6 days prior. This should improve with continued
    healing.
    Last edited by jtuominen; 10-07-2009 at 12:23 PM.

  2. #2
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    Quote Originally Posted by jtuominen View Post
    Hi there-- How would you code the fluoroscopic evaluation of this peritoneal drainage catheter? I am not coming up with anything that feels right--maybe 49424?? or just 76000?? Otherwise All I can think of is the unlisted code 49999. So far I have 49080 for the drainage performed at the end of the procedure.

    HISTORY: 59-year-old with pain after placement of right lower
    quadrant abdominal/pelvic PleurX peritoneal drain.

    TECHNIQUE: The patient was brought to the interventional radiology
    department where there was a long discussion with myself, the patient,
    and his wife. They describe an episode of severe pain near completion
    of drainage several days prior. This pain terminated upon clamping the
    tube. Additional mild low level discomfort within the pelvis and
    within the tunneled tract in the right lower quadrant. There have been
    instances of drainage without discomfort or complication.

    Fluoroscopy was performed to demonstrate placement of the tube. A
    total of 25 mL Hexabrix contrast was administered into the peritoneal
    cavity without complication.

    Fluoroscopy time: 0.7 minutes.
    Sedation: None.
    Local anesthesia: None.

    COMPLICATIONS: None.

    FINDINGS: Spot fluoroscopic image overlying the pelvis demonstrates
    good position of the PleurX peritoneal drainage catheter. The position
    is relatively unchanged compared to previous exam. Contrast collects
    within the pelvic cavity.

    IMPRESSION:
    1. Good position of peritoneal drainage catheter with appropriate
    function. However, the patient describes several episodes of severe
    pain during drainage. Suspect this is due to suction being applied
    upon the bladder, and possibly surrounding loops of bowel. After
    lengthy discussion, it was decided to attempt gravity drainage and
    exclude any form of suction. While in the interventional department
    today, 300 mL of clear yellow fluid was drained without complication
    or discomfort.
    2. Persistent pain in the right lower quadrant when the patient lies
    in a right lateral decubitus position. Suspect this is due to the fact
    the tube was placed 6 days prior. This should improve with continued
    healing.

    Can you ask the physician how the contrast was "administered into the peritoneal cavity"? If through the drainage catheter (likely) then I would code 49424/76080, and I would also ask him/her to revise the document to support the code selection.

    As for charging 49080 for the drainage, I think that was what was drained through the catheter, no additional procedures were performed. IMO

    HTH
    Danny L. Peoples
    CIRCC,CPC

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