PROCEDURE CODE 49082 and 49083

CPT 49082 and 49083

49082 Abd paracentesis Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

49083 Abd paracentesis w/imaging Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance

Correspondence Language Policy/Example Number 14.40000 - Misuse of column two code with column one code

For example, CPT code 49322 describes a surgical laparoscopy with aspiration of single or multiple cavities or cysts (eg, ovarian cyst). CPT code 49082 describes an abdominal paracentesis (diagnostic or therapeutic) without imaging guidance. It is a misuse of CPT code 49082 to report it in addition to CPT code 49322 at the same patient encounter since the procedure described by CPT code 49322 includes the procedure described by CPT code 49082.

49082-49084 Separate Peritoneal

Procedures for More Accurate Coding

Get ready for vascular and skin changes, too. Have you ever been baffled trying to distinguish between an acellular dermal replacement and an acellular dermal allograft? You’ll wonder no more, now that CPT 2012 scraps six families of codes in favor of one new skin-substitute-graft family. We’ve got a look at these changes and more, so read on for tips on how to code your general surgery claims in 2012.

Distinguish Paracentesis, Lavage Prior to Jan.1, 2012, abdominal paracentesis and peritoneal lavage shared codes — meaning that you couldn’t distinguish which procedure your surgeon actually performed. Plus, you needed to know whether your surgeon was performing an initial service or a subsequent peritoneal procedure, a fact that was often difficult to ascertain from the surgeon’s op note.

CPT® 2012 changes all that by deleting the following codes:

49080 — Peritoneocentisis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial

49081 — … subsequent, and replacing them with the following new codes:

49082 — Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

49083 — … with imaging guidance

49084 — Peritoneal lavage, including imaging guidance, when performed.

“You’ll use one of these new codes when your surgeon diagnoses or treats a patient with accumulated peritoneal fluid or possible internal bleeding,” explains Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington  Physicians Compliance Program in Seattle.

Open/lap is different: “Remember to use 49084 only for percutaneous lavage,” Bucknam says. For open lavage, report 49000 (Exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure]) or 49002 (Reopening of recent laparotomy). For laparoscopic lavage, report 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance 

Radiological guidance is typically used when performing an abdominal paracentesis. Whether ultrasound, CT or fluoroscopic guidance is used, the new 2012 surgical CPT codes will include image guidance and will not be separately reportable. These new codes are noted as follows:

CPT 49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance (Status indicator T)

CPT 49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance (Status indicator T)

CPT 49084 Peritoneal lavage, including imaging guidance, when performed (Status indicator T) Since CPT 49082 does not utilize radiological guidance, the chargemaster may certainly not contain this specific procedure.

CPT 49080 Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial and CPT 49081 Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); subsequent have been deleted for 2012. Replacement codes are one of the three new codes discussed above.

Aspiration Procedures

In addition to the fine needle aspiration codes (10021-10022), the CPT® code set contains numerous codes for aspiration of fluid from body cavities, cysts and other fluidcontaining structures. These procedures may be performed for diagnostic purposes (removal of fluid for cytologic examination), therapeutic purposes (relief of pressure caused by fluid build-up) or both.

Paracentesis

Paracentesis is the aspiration of fluid from the abdominal cavity. It is most often performed due to ascites, which is an abnormal accumulation of peritoneal fluid caused by liver disease, cancer or other conditions. Paracentesis may be performed for diagnostic purposes, in which case only a small amount of fluid is removed.

Alternatively, large volume paracentesis may be performed for therapeutic purposes and can involve removal of as much as six liters of fluid. Following large volume paracentesis the patient may receive an albumin infusion to prevent electrolyte imbalances.

The following codes are used to report paracentesis:

CPT® Code Description

49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

49083 . . . with imaging guidance

Remember that aspiration involves removal of the catheter or needle at the conclusion of the procedure. Do not use codes 49082-49083 for drainage procedures in which a catheter is left indwelling. Code 49083 includes imaging guidance, so guidance should not be reported separately.

In the case of ultrasound-guided paracentesis, code 49083 includes the limited ultrasound exam performed prior to paracentesis in order to determine the amount and location of the fluid. 

According to Clinical Examples in Radiology (Winter 2012), “This type of limited sonography is a necessary component of any ultrasound guidance procedure” and should not be coded separately.

If the preliminary ultrasound images do not show any fluid, paracentesis will not be performed. In this situation it is appropriate to report a limited ultrasound exam of the abdomen (76705) for the preliminary imaging.

Finally, ultrasound-guided paracentesis, like other ultrasound-guided procedures, requires permanently archived images. (See Clinical Examples in Radiology, March 2014.)

If the patient receives an albumin infusion following the paracentesis, Coding Clinic™ for HCPCS (Third Quarter 2013) states that the infusion is included in the paracentesis procedure. This guidance applies specifically to hospital billing for outpatient services.

Laparoscopy 

A diagnostic laparoscopy includes “washing”, infusion and/or removal of fluid from the body cavity. 

A physician should not report CPT codes 49082-49083 (abdominal paracentesis) or 49084 (peritoneal lavage) for infusion and/or removal of fluid from the body cavity performed during a diagnostic or surgical laparoscopic procedure.

Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial 49082, 49083, 49084

Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); subsequent 49082, 49083, 49084

Digestive system changes

The AMA added three new codes in the digestive system subsection, including two for abdominal paracentesis (diagnostic or therapeutic):

➤ 49082: Without imaging guidance

➤ 49083: With imaging guidance

Coders should report the third new code, 49084, to denote peritoneal lavage, including imaging guidance, when performed. This is an open procedure that physicians typically perform on acute unstable patients. Physicians use it to assess a patient’s blood for enteric contents and for additional laboratory analysis.

2012 CPT and HCPCS Codes Available for Billing

The following Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes have been updated in the Medicaid Management Information System (MMIS).

Effective immediately, the codes listed below can be billed with dates of service on/after January 1, 2012: 

49082, 49083, 49084

Claims submitted with the dates of service listed above that denied or were cut back because the 2012 codes were not in MMIS will be reprocessed. Providers will be notified when the affected claims are reprocessed.

49082 Abd paracentesis

49083 Abd paracentesis w/imaging

49084 Peritoneal lavage

49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance