Radiology Coding Alert

Beware: A place of service code error for 49418 could cost you more than $1,200.

Confusing terms such as "temporary" and "permanent" are a thing of the past for intraperitoneal (IP) catheter coding. Here's the scoop on how CPT 2011 freshened up your options.

New Code 49418 Starts the IP Catheter Code Changes

Defined as a "complete" procedure, you'll find multiple services covered by new code 49418 (Insertion of tunneled intraperitoneal catheter [e.g., dialysis, intraperitoneal chemotherapy instillation, management of ascites], complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous).

Medicare assigned this new code a 0-day global period, which means Medicare doesn't bundle visits on subsequent days into the procedure payment.

Proceed carefully: Medicare's national fee schedule prices for 49418 differ significantly based on whether you're reporting a facility service ($234.78) or non-facility service ($1,519.08). That's a difference of more than $1,200, so be sure to watch your place of service code.

Correct the Codes Listed in 49419's Line Note

"Overall, changes demonstrate the 'coding lag' that occurs in keeping up with advances in new surgical procedures," says M. Tray Dunaway, MD, FACS, CSP, a surgeon, author, speaker and coding educator with Healthcare Value Inc. in Camden, S.C. And, in fact, the addition of 49418 is part of a larger reworking of tunneled intraperitoneal (IP) catheter codes to bring them in line with current practice. To start with, CPT revises 49419:

• 2010: 49419 -- Insertion of intraperitoneal cannula or catheter, with subcutaneous reservoir, permanent (i.e., totally implantable)
• 2011: 49419 -- Insertion of tunneled intraperitoneal catheter, with subcutaneous port (i.e., totally implantable).

Reason: By referencing subcutaneous port, the code language reflects current technology, according to the General Surgery presentation by Albert Bothe, MD, and Chad Rubin, MD, at the AMA's CPT and RBRVS 2011 Annual Symposium. CPT Changes 2011:

An Insider's View adds that CPT removed the term "cannula" because physicians commonly perform these procedures using a catheter only.

Errata: You'll need to correct the CPT manual note following 49419, according to AMA's published errata. The note should read as follows (changes underlined): "49420 has been deleted. To report open placement of a tunneled peritoneal catheter for dialysis, use 49421. To report open or percutaneous peritoneal drainage or lavage, see 49020, 49021, 49040, 49041, 49080, 49081, as appropriate. To report percutaneous insertion of a tunneled peritoneal catheter without subcutaneous port, use 49418." (Note: Radiology Coding Alert will cover additional 2011 errata in the next issue.)

Focus on 49422 Note Among Other Code Changes

Other changes related to IP catheter coding include the following:

These changes are part of an attempt to "clean up" codes that overlapped and caused confusion, according to the Symposium presentation. For example, the terms temporary and permanent (used in 2010) caused confusion over whether they referred to placement or to the device itself. In addition, CPT 2011 added the term "tunneled" to acknowledge the subcutaneous channel in which the physician places the catheter.

Deletion: Be sure you catch that CPT 2011 deleted 49420. The revisions and additions of other, more specific codes made 49420 obsolete.

Crucial instruction: Don't miss the note with 49422, shown in the table above. Code 49422 is for removal of a tunneled catheter only. If the physician removes a non-tunneled IP catheter, CPT instructs you to report the appropriate E/M code.