Part B Insider (Multispecialty) Coding Alert

CPT deletes intraperitoneal catheter insertion code.

Do you know what CPT changes will affect gastroenterology practices in 2012? Here's a hint: two peritoneocentesis codes will be missing in your CPT manual. Instead, you need to be ready to report new codes as replacements.

Replace Old Peritoneocentesis Codes With Three New Ones

The change will eliminate 49080 (Peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; initial) and 49081 (...subsequent), and will replace them with three new codes:

• 49082 -- Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance
• 49083 -- ...with imaging device
• 49084 -- Peritoneal lavage, including imaging guidance, when performed.

When fluid between abdominal structures in the abdomen accumulates, the physician may perform abdominal paracentesis. CPT 49082 describes the procedure wherein a needle is used to remove a sample of fluid or to drain fluid that has accumulated. This procedure should be performed without image guidance (49083 describes image-guided diagnosis or therapy).

The CPT manual instructs not to report 49083 in conjunction with 76942, 77002, 77012, and 77021 because these radiologic codes describe the possible imaging devices that your physician can use to help with guidance of the paracentesis needle and the services are included within code 49083.

Meanwhile, a physician performs 49084 to determine the presence or absence of internal bleeding within the abdomen. Injury to the abdomen can be caused by blunt forces and penetrating objects. The physician conducts the test by inserting a long, flexible plastic tube into the abdomen through a small incision adjacent to the belly button. He then places fluid into the abdominal cavity through the tube and remove it through the tube for examination. The procedure may include the use of image guidance.

Prepare For Category III Code 0288T

A new Category III code on anoscopy will debut in 2012: 0288T (Anoscopy, with delivery of thermal energy to the muscle of the anal canal (eg, for fecal incontinence). This code describes an examination of the rectum in which the physician inserts a small tube into the anus to screen, diagnose, and evaluate problems of the anus and anal canal. The physician then applies radio frequency energy delivery to cauterize or ablate different types of abnormalities within the rectal area.

Quick fact: The Category III section of your CPT manual contains a temporary set of codes for emerging technologies, services, and procedures.

Example: A 50-year-old male with a history of human papilloma virus or HPV (079.4, Human papillomavirus in conditions classified elsewhere and of unspecified site) presents to the office complaining of intermittent bleeding with bowel movements. A recent colonoscopy turned out negative for any polyps or colon cancer, but identified an area of squamous dysplasia close to the anus. On a subsequent visit the physician performs an anoscopy examination and uses methylene blue solution to stain the area in question for treatment. He also applies radiofrequency ablation to the stained surface destroying the abnormal mucosa.

Refresh Your Deleted Code List To Include 78220-78223

Other gastroenterology-related CPT changes that will occur in 2012 include the deletion of codes:

• 49420 -- Insertion of intraperitoneal cannula or catheter for drainage or dialysis; temporary
• 78220 -- Liver function study with hepatobiliary agents, with serial images
• 78223 -- Hepatobiliary ductal system imaging, including gallbladder, with or without pharmacologic intervention, with or without quantitative measurement of gallbladder function
• 91012 -- Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study; with acid perfusion studies.