General Surgery Coding Alert

Question: I submitted a claim for the removal of a pd cath from right side of abdomen (49422) and laparoscopic insertion of a new pd cath on left side of abdomen (49324). The insurance company denied the removal as being included in the first procedure. It was two separate procedures with separate incisions. Am I correct to report both codes and appeal this denial?

New Jersey Subscriber

Answer: You are correct to report both codes. You should use 49422 (Removal of permanent intraperitoneal cannula or catheter) for the pd catheter removal and 49324 (Laparoscopy, surgical; with insertion of intraperitoneal cannula or catheter) for the surgeon's placing of the new pd catheter. Make sure that you append modifier 59 (Distinct procedural service) to show the insurance company that the procedures were indeed separate procedures. With an appeal and the proper documentation, you should see payment.

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program.