Radiology Coding Alert

Question: I am getting a denial from Medicare for the use of 49083, 99070, 36410, and 12001. Are all of these codes incidental to 49083?

Codify Member

Answer: Based on the codes you’ve listed, 49083 (Abdominal paracentesis [diagnostic or therapeutic]; with imaging guidance) should represent the entire service provided to the patient.

Here’s why: Medicare bundles payment for supply code 99070 (Supplies and materials [except spectacles], provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) into other procedures performed on the same date. The Medicare Physician Fee Schedule (MPFS) indicates this by giving 99070 status B.

The Correct Coding Initiative (CCI) provides a couple of clues to let you know 36140 (Venipuncture …) and 12001 (Simple repair …) aren’t separately reportable in addition to 49083.

First, CCI bundles 12001 and 36140 into 49083. You could override the edits with a modifier, but only if the venipuncture and repair were distinct from the paracentesis.

Second, the CCI manual states, “A physician should not unbundle services that are integral to a more comprehensive procedure.” In other words, if a procedure routinely requires certain steps, you shouldn’t code those steps separately. CMS takes those steps into account when creating the fee for the main procedure code. The CCI manual lists IV access and surgical closure as typical integral services. For more information, see Chapter I.A of the manual, which is posted at www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html