Gastroenterology Coding Alert

Question: Is there a specific quantity (liters) or time increment that must be met in order to bill for an extended procedure using modifier -22 on code 49080 (peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; initial)? I have informed my physician that it would certainly need to be documented in the operative note that it was an extended service and an explanation as to why it was extended. However, we are wondering if there is a set amount as far as quantity or time.

Laurie Craig
Metro East Gastroenterology Ltd., Belleville, Ill.

Answer: Peritoneocentesis, abdominal paracentesis or peritoneal lavage all refer to the drainage of fluid from the abdominal cavity. Code 49080 is used to report the initial procedure, while code 49081 (peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; subsequent) is used to report a subsequent drainage and/or lavage procedure. Codes 49080 and 49081 are listed as mutually exclusive codes in the Correct Coding Initiative (CCI), which means that they cannot be reported together on the same day.

The CPT definition of codes 49080-49081 does not specify any parameters regarding the quantity of fluid used in the lavage or the amount of time spent performing the procedure, so it may be difficult to get extra reimbursement by attaching modifier -22 (unusual procedural services). Each insurance carrier will have its own criteria of what would constitute an unusual procedural service in this situation.

The gastroenterologist should document not only the extenuating circumstances as far as difficulty and quantity, but also give some comparative descriptions that illustrate this case has a significant level of difficulty beyond the average performance of the procedure.