paracentesis cpt code

Paracentesis CPT Code (2022) Description, Guidelines, Reimbursement, Modifiers & Examples

Paracentesis CPT code(s) 49082 and 49083 report for service when the physician performs abdominal paracentesis with or without imaging guidance. The physician removes the excess fluid that accumulates in the abdomen region. It also aids in viewing the area in some cases. 

Paracentesis CPT Code Description 

The fluid accumulates because of an acute abdominal injury, cancers, infections, and liver cirrhosis. Excessive fluid can cause shortness of breath and pain.

The following are the reasons why the physician performs paracentesis: 

To identify cancerous tumor

To remove excessive fluids in the abdominal cavity to lower respiratory stress.

To assess acute abdomen conditions  

To assess acute or spontaneous peritonitis 

To assess acute pancreatitis 

The physician incorporates a needle or catheter abdominal cavity and withdraws and drains fluid for diagnostic or therapeutic purposes.

Paracentesis CPT code 49082 reports for service when the physician performs abdominal paracentesis without imaging guidance. 

Paracentesis CPT code 49083 reports for service when the physician performs abdominal paracentesis with imaging guidance.

cpt code for paracentesis

Paracentesis CPT Code Reimbursement

A maximum of one unit can be a bill on the same service date of Paracentesis CPT code 49082-49083. In contrast, the three units allow documentation supporting the service’s medical necessity.

The cost and RUVS of CPT 49082 are $79.63 and 2.30110 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49082 are $255.29 and 7.37710 when performed in the non-facility.

The cost and RUVS of CPT 49083 are $114.51 and 3.30908 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49083 are $353.20 and 10.20633 when performed in the non-facility.

cpt code paracentesis

Paracentesis CPT Code Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.  

The following are ICD category 10 Payable Dx codes and report the specified level of dx code accordingly:

A18.31, A52.74, C22.x, C78.x, D72.829, E87.2, E87.70, E87.79, I50.9, I81, I89.8, K56.5x, K65.0, K65.x, K66.8, K66.1, K66.9, K67, K70.xx, K72.xx, K74.xx, K78.89, K75.9, K76.89, K85.XX, K86.0, K86.1, K86.89, K86.9, K87. K91.xx, N18.xx, N25.89, N25.9, N25.9, R18.0, R18.8, S30.xxxx, S36.xxxx, and T79.xxx.

Suppose Image-guided percutaneous drainage and retroperitoneal abscess via a catheter (49406) perform in combination with Paracentesis CPT code(s) 49083 and 49082. It is appropriate to report 49082-49083 with the appropriate modifier.

Diagnostic and therapeutic procedures can bill with these procedure Paracentesis CPT code(s) 49082 and 49083. There is no separate code available for these procedures. 

CPT 49083 includes Radiological guidance (76942, 77002, 77012, 77021), do not report separately.

It is appropriate to report Peritoneal lavage with CPT 49084 instead of CPT 49083 or 49082.

paracentesis with ultrasound guidance cpt code

Paracentesis CPT Code Modifiers

The following are the list modifiers when Paracentesis CPT code(s) 49082 and 49083 bills:

22, 23, 47, 51, 52, 53, 58, 59, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, ET, EY, FX, FY, GA, GC, GK, GR, GU, GY, GZ, KX, PT, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS.

Modifier 76 is applicable with CPT 49082 AND 49083 when a similar service performs by the Same Physician on the same service date.

Modifier 76 is applicable with Paracentesis CPT code(s) 49082 AND 49083 when a similar service performs by a different Physician on the same service date.

Modifier 59 is applicable with CPT 49082 AND 49083 when Distinct service performs by the physician and bundles with another procedure on the same date.  

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT 49082 AND 49083 when service bills to medicare insurance. It divides the modifier into four parts for further specification of the procedure.

Modifier 53 will be reported with CPT 49082 AND 49083 if unsuccessful paracentesis occurs due to unavoidable circumstances like allergic reactions to the substance.

Modifier 22 applies to CPT 49082 AND 49083 when services perform longer than usual and take extra resources during the procedure.

Modifier 23 is applicable with CPT 49082 AND 49083 when general or local anesthesia administers by the physician and routinely does not require during the procedure.

Modifier 52 applies when the physician does not complete the lumbar puncture procedure and service terminates due to unavoidable circumstances.

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN). CPT 49082 AND 49083 must apply the GA modifier to that service.

Paracentesis CPT Code Examples

The following are examples when Paracentesis CPT code(s) 49082 and 49083 bills:

Example 1

PARACENTESIS

Clinical information: ascites

The operator is ABC

The supervising physician is Dr. XYZ

Informed consent obtains from the patient. Risks of infection, bleeding, pain, damage to adjacent structures, and allergic reaction were all discussed with the patient, who understood and consented to proceed. 

The patient evaluates sonographically, and the appropriate puncture site was determined and marked on the right mid quadrant. Images archived to PACS for documentation purposes. 

The patient prepares for the procedure in a standard sterile fashion. The skin and subcutaneous tissues infiltrate with lidocaine, and a 5 French Yueh catheter advanced into the fluid. The team timeout confirmed the appropriate patient identity and procedure. 

The catheter was attached to suction drainage. A total of 2.9 liters of clear yellow fluid remove.

The patient tolerated the procedure well, and there were no immediate complications.

No fluoroscopy utilizes for this exam.

Impression:

Successful sonographically guided paracentesis with the removal of 2.9 liters of clear yellow fluid without immediate complication.

Example 2

PARACENTESIS

Clinical information: Increasing ascites

An operator is ABC

The supervising physician is Dr. XYZ

Informed consent obtains from the patient. The physician discusses the risk of infection, bleeding, pain, damage to adjacent structures, and allergic reaction. 

The patient evaluates sonographically, and the appropriate puncture site was determined and marked on the left lower quadrant. Images archives to PACS for documentation purposes.

The patient prepared for the procedure in a standard sterile fashion. The team timeout confirmed the appropriate patient identity and function. The skin and subcutaneous tissues infiltrate with lidocaine, and a 5 French Yueh catheter advanced into the fluid.

The catheter was attached to suction drainage. A total of 1.8 liters of clear yellow fluid removes from the patient’s body.

The patient tolerated the procedure well, and there were no immediate complications.

No fluoroscopy utilizes for this exam.

Impression:

Successful sonographically guided paracentesis with the removal of 1.8 liters of clear yellow fluid without immediate complication.

Example 3

PARACENTESIS

Clinical information: significant volume ascites, cirrhosis

The operator is ABC

The supervising physician is Dr. XYZ

Informed consent obtains from the patient. Risks of infection, bleeding, pain, damage to adjacent structures, and allergic reaction were discussed with the patient, who understood and consented to proceed.

The patient was evaluated sonographically, and the appropriate puncture site was determined and marked on the right lower quadrant. Images archives to PACS for documentation purposes.

The patient prepares for paracentesis in a typical sterile fashion. The team timeout confirmed the appropriate patient identity and procedure. The skin and subcutaneous tissues infiltrate with lidocaine, and a 5 French Yueh catheter advanced into the fluid.

The catheter was attached to suction drainage. A total of 3.6 liters of clear yellow fluid remove.

A sample of fluid was sent to the lab as requested. The patient tolerates the procedure well and has no immediate complications.

No fluoroscopy utilizes for this exam.

Impression:

Successful sonographically guided paracentesis with the removal of 3.6 liters of clear yellow fluid without immediate complication.

Example 4

PARACENTESIS

Clinical information: ascites

The operator is ABC

The supervising physician is XYZ.

Informed consent obtains from the patient. Risks of infection, bleeding, pain, damage to adjacent structures, and allergic reaction were discussed with the patient, who understood and consented to proceed.

The patient was evaluated sonographically, and the appropriate puncture site was determined and marked on the right mid quadrant. Images archives to PACS for documentation purposes. The patient prepares for the procedure in a typical sterile fashion.

The team timeout confirmed the appropriate patient identity and function. The skin and subcutaneous tissues infiltrate with lidocaine, and a 5 French Yueh catheter advanced into the fluid.

The catheter was attached to suction drainage. A total of 6.4 liters of clear yellow fluid removes from the body.

The patient tolerated the procedure well, and there were no immediate complications.

No fluoroscopy utilizes for this exam.

Impression:

Successful sonographically guided paracentesis with the removal of 6.4 liters of clear yellow fluid without immediate complication.

Example 5

ULTRASOUND-GUIDED PARACENTESIS

CPT 49083

CLINICAL INDICATION: Recurrent ascites

Informed consent obtains from the patient. A limited ultrasound of the abdomen performs for localizing purposes. The left lower abdomen was prepped and draped. The physician administers the anesthesia to The skin and subcutaneous tissues with 1% lidocaine.

A small skin incision makes with an 11 blade. With ultrasound guidance, a Yueh needle advance into the peritoneal cavity. The sheath was stripped from the trocar. A sonographic image obtains for documentation.

Approximately three litres of serosanguineous ascites drain from the body. Samples were sent for laboratory analysis as ordered by Dr. Canavan. The remainder of the fluid eliminates. The sheath removes, and the puncture site is cleansed and dressed in the usual fashion. The patient tolerated the procedure well.

IMPRESSION:

1. Successful diagnostic and therapeutic paracentesis with 3 L of ascites removed. Samples were sent for laboratory analysis.

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