How To Use CPT Code 49405

CPT 49405 describes the image-guided fluid collection drainage by catheter for visceral organs such as the kidney, liver, spleen, lung/mediastinum. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 49405?

CPT 49405 can be used to describe the image-guided drainage of fluid collections in visceral organs such as the kidney, liver, spleen, and lung/mediastinum. This code is used when a catheter is percutaneously placed under imaging guidance to provide continuous drainage of a fluid collection, such as an abscess, hematoma, seroma, lymphocele, or cyst.

2. Official Description

The official description of CPT code 49405 is: ‘Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous.’

3. Procedure

1. The provider preps and sedates the patient.
2. Using imaging guidance, the provider locates the fluid collection to be drained.
3. A catheter is percutaneously placed in the abdomen or chest area to provide continuous drainage of the fluid collection.
4. One or more catheters may be placed depending on the size and location of the fluid collection.
5. The service may also include catheter maintenance and eventual removal of the catheter(s).

4. Qualifying circumstances

Patients eligible to receive CPT 49405 services are those with fluid collections in visceral organs such as the kidney, liver, spleen, and lung/mediastinum. The procedure must be performed percutaneously and under imaging guidance. The fluid collection may be an abscess, hematoma, seroma, lymphocele, or cyst.

5. When to use CPT code 49405

CPT code 49405 should be used when a provider performs image-guided fluid collection drainage by catheter for visceral organs. It is important to note that CPT code 49405 should not be reported in conjunction with codes 75989, 76942, 77002, 77003, 77012, or 77021. For specific procedures such as percutaneous cholecystostomy, pneumonostomy, thoracentesis, or percutaneous pleural drainage, other appropriate codes should be used.

6. Documentation requirements

To support a claim for CPT 49405, the provider must document the following information:

• Patient’s diagnosis and the need for fluid collection drainage
• Imaging guidance used during the procedure
• Date and duration of the procedure
• Specific organ involved and the type of fluid collection
• Number of catheters placed
• Any catheter maintenance or removal performed
• Signature of the provider performing the service

7. Billing guidelines

When billing for CPT 49405, ensure that the procedure is performed percutaneously and under imaging guidance. It is important to note that CPT code 49405 should not be reported with codes 75989, 76942, 77002, 77003, 77012, or 77021. Other specific procedures have their own appropriate codes. Follow the guidelines provided by the payer and use the appropriate modifiers if necessary.

8. Historical information

CPT 49405 was added to the Current Procedural Terminology system on January 1, 2014. There have been no updates to the code since its addition.

9. Examples

1. A radiologist performing image-guided drainage of a liver abscess using a percutaneous catheter.
2. An interventional radiologist using imaging guidance to drain a kidney hematoma with a percutaneous catheter.
3. A pulmonologist performing image-guided drainage of a lung abscess using a percutaneous catheter.
4. An interventional radiologist using imaging guidance to drain a spleen seroma with a percutaneous catheter.
5. A thoracic surgeon performing image-guided drainage of a mediastinal lymphocele using a percutaneous catheter.
6. An interventional radiologist using imaging guidance to drain a kidney cyst with a percutaneous catheter.
7. A gastroenterologist performing image-guided drainage of a pancreatic pseudocyst using a percutaneous catheter.
8. An interventional radiologist using imaging guidance to drain a perirenal abscess with a percutaneous catheter.
9. A pulmonologist performing image-guided drainage of a lung abscess using multiple percutaneous catheters.
10. An interventional radiologist using imaging guidance to drain a liver abscess with a percutaneous catheter and performing catheter maintenance.