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CPT Codes for Paracentesis and Peritoneal Lavage

<div style="text-align:justify;">The new CPT Codes for Abdominal Paracentesis and Peritoneal Lavage are 49082 and 49083. These paracentesis CPT codes describe the procedures performed without or with imaging guidance. 
 
If the healthcare professional performs abdominal paracentesis without imaging guidance, CPT code 49082, Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance will be applied. 
 
If abdominal paracentesis is performed with imaging guidance (regardless of the method used), CPT code 49083, Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance will be used in the medical coding and billing of that claim. 
 
CPT Code 49084, Peritoneal lavage, including imaging guidance; when performed is used to describe the procedure where a vertical skin incision is made. The linea alba is divided and the peritoneum entered after it has been picked up to prevent bowel perforation. A catheter is inserted towards the pelvis and aspiration of material is attempted using a syringe. If no blood is aspirated, warm saline is infused and after a few minutes, the effluent is drained and sent for analysis. 
 
<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2012/05/cpt-codes-2012-for-abdominal.html"><img alt="CPT Codes for Abdominal Paracentesis and Peritoneal Lavage" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1uU8atjx2yqycuRDEXvlFbEdfJHPp2nzbSFrOIZbL4uqLKBWLaIIoS28ZvxJcNgKN2bbYO6ogv3UxHg3L-jjgQOzAcYeNggkqK5uwHo1yQMPkqaPvuLoLtPaTDG4IutDSB3Tb0MV5SsU/s1600/medical+billing.bmp" /></a></div> 
Parentheticals are included with CPT codes 49083 and 49084 instructing the provider not to report these codes with separate imaging codes. It includes ultrasonic guidance CPT code 76942, fluoroscopic guidance CPT code 77002, computed tomography guidance CPT code 77012, and/or magnetic resonance guidance CPT code 77021. 
 
<h2>CPT Codes for Paracentesis and Peritoneal Lavage</h2>Here are the Surgery / Digestive System Abdomen, Peritoneum and Omentum Incision CPT codes changes. The following two CPT Codes have been deleted: 
<ul><li>CPT 49080 Peritoneocentesis, abdominal paracentesis or peritoneal lavage (diagnostic or therapeutic); initial</li>
<li>CPT 49081 Peritoneocentesis, abdominal paracentesis or peritoneal lavage (diagnostic or therapeutic); subsequent</li>
</ul>The following three CPT Codes have replaced the above codes: 
<ul><li>CPT 49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance</li>
<li>CPT 49083 with imaging guidance</li>
<li>CPT 49084 Peritoneal lavage, including imaging guidance, when performed</li>
</ul><h3>Paracentesis CPT Code Changes</h3>As we have mentioned that CPT 49080 and 49081 has been deleted. While the CPT Code 49083 includes imaging guidance. Please do not report CPT 49083 in conjunction with CPT codes 76942, 77002, 77012 or 77021. Peritoneal lavage with imaging guidance is reported with 49084, when performed. 
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CPT Codes for Paracentesis and Peritoneal Lavage

The new CPT Codes for Abdominal Paracentesis and Peritoneal Lavage are 49082 and 49083. These paracentesis CPT codes describe the procedures performed without or with imaging guidance. If the healthc…

MEDICAL CODING BASICS And RISK OF COMPLICATIONS AND MORBIDITY OR MORTALITY

There is often risk involved in medical care, either from the treatment given to the patient or from the lack of treatment and professional care. Morbidity, the relative incidence  of disease, and mortality, which relates to the number of deaths from a given disease, are part of the assessment of risks made by the physician.<o:p></o:p> 
 
<div class="MsoNormal" style="margin: 0in 0in 5.75pt; tab-stops: 0in; text-align: justify;">These three elements play a role in the complexity of the decision-making process used when treating a patient. The physician determines the level of care given to a patient, but must consider these three factors when choosing the E&M levels assigned to a patient on a given encounter. The physician cannot base the choice of E&M levels solely on the time spent with the patient. All elements must be considered when assigning the code. Usually, the physician circles this service code and other procedure codes on the encounter form as or just after the patient is seen in the office. Although a physician may allow the medical assistant to make notations on the encounter form, only the physician makes the decision as to which services and procedures are performed.<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: 20.85pt; margin: 0in 0in 0pt; text-align: justify;">MEDICAL DECISION-MAKING COMPLEXITY LEVELS<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt 20.25pt; mso-line-height-alt: 10.8pt; text-align: justify; text-indent: 0.75pt;">Straightforward:  Minimal diagnosis/management options, minimal/none for the amount and complexity<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt 20.25pt; mso-line-height-alt: 10.8pt; text-align: justify; text-indent: 0.75pt;">of data to be reviewed, and minimal risk to the patient of complications or death if untreated.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt 20.25pt; mso-line-height-alt: 10.8pt; text-align: justify; text-indent: 0.75pt;">Low-complexity:  Limited number of diagnoses/ management options, limited data to be reviewed, and low risk to the patient of complications or death if untreated.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt 20.25pt; mso-line-height-alt: 10.8pt; text-align: justify; text-indent: 0.75pt;">Moderate-complexity:  Multiple diagnoses/management options, moderate amount and complexity of data to be reviewed, and moderate risk to the patient of complications or death if untreated.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt 20.25pt; mso-line-height-alt: 10.8pt; text-align: justify; text-indent: 0.75pt;">High-complexity:  Extensive diagnoses/management options, extensive amount and complexity of data to be reviewed, and high risk to the patient for complications and/or death if the problem is untreated.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt 20.25pt; mso-line-height-alt: 10.8pt; text-align: justify; text-indent: 0.75pt;"> 
</div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt; mso-line-height-alt: 10.8pt; text-align: justify; text-indent: 0.75pt;">EXAMINATION<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt;">The examination is the objective part of the patient's visit. The physician examines the patient and makes notes referring to body areas and/or organ systems:<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 22.5pt;">Body areas:  Head including face and neck, chest, including breasts and axillas, abdomen, genitourinary (GU), back, including spine and extremities.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 22.5pt;">Organ systems:  Constitutional, eyes, ears/nose/throat and mouth, cardiovascular, respiratory, gastrointestinal (Gl), GU, musculoskeletal, skin, neurological, psychiatric, and hematological/lymphatic/immunologic.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt;">The examination is divided into the following levels:<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 22.5pt; tab-stops: 34.25pt; text-align: justify;">Problem focused:  The examination is limited to the single body area or single system mentioned in the chief complaint.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 22.5pt;">Expanded problem focused:  In addition to the limited body area or system, related body areas or organ systems are examined.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 22.5pt; tab-stops: 44.1pt; text-align: justify;">Detailed:  An extended examination is performed on the related body areas or organ systems.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 22.5pt;">Comprehensive:  A "complete" multi-system examination is performed.<o:p></o:p></div> 
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<div class="MsoNormal" style="margin: 0in 0in 0pt; mso-line-height-alt: 11.25pt; tab-stops: 9.05pt; text-align: justify; text-indent: 0.75pt;">CONTRIBUTING FACTORS<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt; text-align: justify;">Although the determining factors just discussed are the basis for E&M coding, there are circumstances in which other factors contribute to determining the level of service.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 21.75pt; text-align: justify;">Counseling.  Almost all E&M services contain a degree of counseling with the patient and/or the family. This is factored into the E&M code, and as long as this factor does not exceed 50 % of the time spent with the patient, it is included in the E&M code.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 21.75pt; text-align: justify;">Coordination of Care.  Some patients need assistance in arranging for care beyond the visit or hospitalization. Some will need care in a skilled nursing facility or home health care. Others will need hospice care. The primary physician usually coordinates this care.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 21.75pt; text-align: justify;">Nature of the Presenting Problem.  The presenting problem is usually explained in the chief complaint. It can range from something as simple as a cold in an otherwise healthy patient to a life-threatening problem.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 21.75pt; text-align: justify;">Time.  CPT has provided assigned times for each of the CPT E&M codes. Time should not be the determining factor, with one exception: if more than 50 % of the visit is spent counseling, only time determines the level of complexity.<o:p></o:p></div> 
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<div class="MsoNormal" style="margin: 0in 0in 0pt; mso-line-height-alt: 10.8pt; text-align: justify;">PUTTING IT ALL TOGETHER TO DETERMINE THE CODE<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt; mso-line-height-alt: 10.8pt; text-align: justify;"> 
</div> 
<ol start="1" style="margin-top: 0in;" type="1"><li class="MsoNormal" style="margin: 0in 0in 4.3pt; mso-list: l0 level1 lfo1;">Determine whether the patient is new or established.<o:p></o:p></li>
<li class="MsoNormal" style="margin: 0in 0in 4.3pt; mso-list: l0 level1 lfo1;">Where is the patient being seen-office, hospital, or other setting?<o:p></o:p></li>
<li class="MsoNormal" style="margin: 0in 0in 4.3pt; mso-list: l0 level1 lfo1;">Is this a patient of the practice, or is someone requesting a consultation?<o:p></o:p></li>
<li class="MsoNormal" style="margin: 0in 0in 4.3pt; mso-list: l0 level1 lfo1;">Is the patient "sick" or here for preventative medicine services?<o:p></o:p></li>
</ol> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 0.5in; mso-list: l0 level1 lfo1; tab-stops: 7.4pt; text-align: justify; text-indent: -0.25in;">5.      Is the history problem-focused, expanded problem-focused, detailed, or comprehensive?<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 0.5in; mso-list: l0 level1 lfo1; tab-stops: 7.4pt; text-align: justify; text-indent: -0.25in;">6.      Is the examination problem-focused, expanded problem-focused, detailed, or comprehensive?<o:p></o:p></div> 
<ol start="7" style="margin-top: 0in;" type="1"><li class="MsoNormal" style="margin: 0in 0in 4.3pt; mso-list: l0 level1 lfo1;">Is medical decision making straightforward, low, moderate, or high?<o:p></o:p></li>
<li class="MsoNormal" style="margin: 0in 0in 4.3pt; mso-list: l0 level1 lfo1;">Pick the code.<o:p></o:p></li>
</ol> 
<div class="MsoNormal" style="line-height: 18.45pt; margin: 0in 0in 0pt; text-align: justify;">CPT Coding Definitions<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 21pt;">Bundled codes describe procedures or services that are grouped together and paid as one. An example would be code 90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine for intramuscular use.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 21pt;">Unbundled codes describe separating the components of a procedure and reporting them separately. To use the diphtheria example, if someone reports the three vaccines separately, it gives the impression that three injections rather than one were given.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 21pt;">Upcoding is a deliberate increase in a CPT code to receive higher reimbursements. This is a target of CMS investigations and should never be done.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 4.3pt 21pt;">Downcoding is usually done by the insurance companies if, on review, the examiner feels the documentation does not match the code description.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt 21pt; mso-line-height-alt: 10.8pt;"> 
</div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt; mso-line-height-alt: 10.8pt; text-align: justify;">CRITICAL THINKING APPLICATION<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt; mso-line-height-alt: 10.8pt;">If a patient was referred for epigastric pain and if; Shuman performed an ultrasound  examination of the gallbladder, what would Kay need to consider to properly code this encounter?<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt; mso-line-height-alt: 10.8pt;"> 
</div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt; mso-line-height-alt: 9.1pt; text-align: justify;">CODING TIPS AND HINTS<o:p></o:p></div> 
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<div class="MsoNormal" style="margin: 0in 0in 0pt 53.25pt; mso-line-height-alt: 10.8pt; mso-list: l1 level1 lfo2; text-indent: -0.25in;">●      Always have the latest edition of CPT and HCPCS. . Follow the “CCI” information quarterly. . Never code something because it is "close" to the description; research it further.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt 53.25pt; mso-line-height-alt: 10.8pt; mso-list: l1 level1 lfo2; text-align: justify; text-indent: -0.25in;">●      Review the guidelines and refer to them as part of your routine. It would be extremely difficult for anyone person to know all the specific guidelines.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt 53.25pt; mso-line-height-alt: 10.8pt; mso-list: l1 level1 lfo2; text-indent: -0.25in;">●      Keep the lines of communication open with the physician and never hesitate to ask for clarification.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt 53.25pt; mso-line-height-alt: 10.8pt; mso-list: l1 level1 lfo2; text-indent: -0.25in;">●      Develop am! use an audit sheet that you are comfortable with and do periodic code reviews. This may not be your responsibility, but understanding how a chart auditis done can help you in your coding responsibilities.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt 53.25pt; mso-line-height-alt: 10.8pt; mso-list: l1 level1 lfo2; text-indent: -0.25in;">●      Know the modifiers and use them when appropriate.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt 53.25pt; mso-line-height-alt: 10.8pt; mso-list: l1 level1 lfo2; text-indent: -0.25in;">●      Know abbreviations, especially for laboratory procedures.<o:p></o:p></div> 
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<div class="MsoNormal" style="line-height: 18.7pt; margin: 0in 0in 0pt; text-align: justify;"> Legal  and Ethical Issues<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt; mso-line-height-alt: 10.8pt; text-align: justify;">Medical assistants must be responsible and remain knowledgeable about CPT to ensure that no fraud takes place in the coding and claims submission process. Medical assistants should also ensure that proper precautions are taken to avoid incorrect coding, data entry errors, and false claims submissions.<o:p></o:p></div> 
<div class="MsoNormal" style="margin: 0in 0in 0pt; mso-line-height-alt: 10.8pt; text-align: justify;"> 
</div>Codes or narratives should not be altered in patient chart documentation to increase insurance reimbursement or to accommodate policy coverage requirements. Deliberate misrepresentation may carry criminal and/or civil penalties

MEDICAL CODING BASICS And RISK OF COMPLICATIONS AND MORBIDITY OR MORTALITY

There is often risk involved in medical care, either from the treatment given to the patient or from the lack of treatment and professional care. Morbidity, the relative incidence of disease, and mo…

Pacemaker System Implant Procedure Coding and Billing Description

1.The subclavian vein is accessed and a pulse generator pocket is formed. 
2.Under fluoroscopy, the pacing lead(s) are inserted into the right atrium (33206) or right ventricle (33207) for a single chamber system, or into the right atrium and right ventricle for a dual chamber system (33208). 
3.Lead measurement tests, including pacing and sensing thresholds and lead impedances, are performed. 
4.The pacemaker pulse generator (included in 33206, 33207, and 33208) is connected to the lead(s) thatare in place. 
 
 
 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">PACEMAKER 2012 Billing and Coding Guide <o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">Commonly Billed Pacemaker Scenarios<o:p></o:p></div> Key:Moderate sedation (For these procedures, moderate [conscious] sedation is included and cannot be billed separately when provided by the same physician. See AMA’s 2012 Current Procedural Terminology for specific guidelines.)<o:p></o:p> 
 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">+ Add-on code<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">Physician CPT® Codes1<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">Hospital Outpatient CPT® Codes2<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">Hospital Inpatient ICD-9-CM Codes3<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;"> 
</div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">1.1 Initial single chamber rate-responsive pacemaker system implant with right atrial lead<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">Scenario 1.1: Physician CPT® Codes1<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">33206 Insertion of new or replacement of permanent pacemaker with transvenous<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">electrode(s); atrial<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">Scenario 1.1: Hospital Outpatient CPT® Codes2<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">33206 Insertion of new or replacement of permanent pacemaker with transvenous<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">electrode(s); atrial<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">Scenario 1.1: Hospital Inpatient ICD-9-CM Codes3<o:p></o:p></div> <o:p> </o:p> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">37.73 Initial insertion of transvenous lead [electrode] into atrium<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">Excludes:<o:p></o:p></div> • Insertion of temporary transvenous pacemaker system (37.78) <o:p></o:p> 
 • Replacement of atrial and/or ventricular lead(s) (37.76)<o:p></o:p> 
 37.82 Initial insertion of single chamber device, rate responsive<o:p></o:p> 
 • Rate responsive to physiologic stimuli other than atrial rate<o:p></o:p> 
 Excludes:<o:p></o:p> 
 • Replacement of existing pacemaker device (37.85–37.87)<o:p></o:p> 
 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;"> 
</div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">1.2 Initial single chamber rate-responsive pacemaker system implant with right ventricular<o:p></o:p></div> lead<o:p></o:p> 
 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">Scenario 1.2: Physician CPT® Codes1<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">33207 Insertion of new or replacement of permanent pacemaker with transvenous<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">electrode(s); ventricular<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">Scenario 1.2: Hospital Outpatient CPT® Codes2<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">33207 Insertion of new or replacement of permanent pacemaker with transvenous<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">electrode(s); ventricular <o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">Scenario 1.2: Hospital Inpatient ICD-9-CM Codes3<o:p></o:p></div> 
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">37.71 Initial insertion of transvenous lead [electrode] into ventricle<o:p></o:p></div> Excludes:<o:p></o:p> 
 • Insertion of temporary transvenous pacemaker system (37.78) <o:p></o:p> 
 • Replacement of atrial and/or ventricular lead(s) (37.76)<o:p></o:p> 
 37.82 Initial insertion of single chamber device, rate responsive<o:p></o:p> 
 • Rate responsive to physiologic stimuli other than atrial rate<o:p></o:p> 
 Excludes:<o:p></o:p> 
 • Replacement of existing pacemaker device (37.85-37.87)

Pacemaker System Implant Procedure Coding and Billing Description

1.The subclavian vein is accessed and a pulse generator pocket is formed. 2.Under fluoroscopy, the pacing lead(s) are inserted into the right atrium (33206) or right ventricle (33207) for a single c…

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CPT Codes for Paracentesis and Peritoneal Lavage

MEDICAL CODING BASICS And RISK OF COMPLICATIONS AND MORBIDITY OR MORTALITY

Pacemaker System Implant Procedure Coding and Billing Description

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