Clearing Away the Confusion Surrounding Catheter-Assisted Drainage

At one time, several codes detailed “abscess” for catheter-assisted drainage. However, the AMA has since eliminated these codes. So, what has happened with these codes since then, and what replaced them? What are the nuances worth noting for correct code comprehension? Let’s explore the details in this area of interventional radiology, to enable coding success now and moving forward.

Coding Facts for Comprehension

As stated previously, four codes now define catheter-assisted fluid drainage. The codes are reported when an indwelling catheter is used to drain fluid collections. These include collections such as:

• abscess,
• hematoma,
• seroma,
• lymphocele,
• or cyst.

Terms such as “indwelling catheter” may cause confusion for some coders. An indwelling catheter is one left in place for longer-term drainage. If fluid is initially aspirated and then an indwelling catheter is placed (during the same session, at the same location), assign only the catheter-drainage code.

In other scenarios, the code assignment may prove to be different than initially anticipated. For instance, when a catheter is placed for drainage but removed at the end of the same session, an aspiration or unlisted code should be assigned instead of 10030 or 49405–49407. CPT^® S&I code 75989, previously assigned for abscess drainage, is still a valid code in the CPT manual but is only linked to code 32550 (tunneled pleural catheter placement).

10030

Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst), soft tissue (e.g., extremity, abdominal wall, neck), percutaneous

Which code should be reported for percutaneous soft-tissue drainage using an indwelling catheter? Assign 10030 for each separate collection drained with a catheter under imaging guidance of any kind. Do not add 75989 or any of the modality-specific guidance codes.

10160	Puncture aspiration of abscess, hematoma, bulla, or cyst
17999	Unlisted procedure, skin, mucous membrane and subcutaneous tissue

Soft tissue drainage, however, is a little trickier when using needle aspiration. Assign code 10160 instead of 10030 for soft tissue drainage by needle aspiration. Report an unlisted code such as 17999 if a temporary catheter is placed for soft tissue fluid drainage and removed at the end of the session.

49405

Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); visceral (e.g., kidney, liver, spleen, lung/mediastinum), percutaneous

Coding Circumstances and Scenarios

“Visceral” is another term worth exploring for proper understanding. Although we tend to think of “visceral” as pertaining to organs in the abdominal cavity. In reality, it actually applies to organs in all three of the great cavities of the body (thoracic, abdominal, pelvic).

It is proper to assign 49405 for percutaneous image-guided catheter drainage of a fluid collection in an organ in any of these cavities. Understand that this code is used for percutaneous drainage of a lung abscess but should not be assigned for draining pleural fluid.

Code 49405 is assigned for drainage of a renal abscess but should not be used for nephrostomy tube or ureteral stent placement for drainage. Nor would 49405 be assigned for biliary drainage. It is appropriate to assign code 49405 for each individual collection drained by a separate catheter. However, do not add code 75989 or any of the modality-specific guidance codes.

If a visceral fluid collection is drained without a catheter being left in place and no other more specific code exists, assign a body area unlisted code.

49406

Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous

When is code 49406 reported? Code 49406 is assigned for percutaneous catheter drainage of fluid collections in the peritoneum or retroperitoneum that are not within an organ. Do not use this code for transvaginal or transrectal drainage of fluid within the peritoneum or retroperitoneum.

Note that some overlap exists between code 49406 and the paracentesis code 49083. Code 49406  should be assigned for organized collections of fluid, instead of generalized fluid. In addition, catheter placement with 49406 will normally be longer lasting than a catheter that may be placed and removed for drainage of ascites.

You may assign code 49406 for each catheter placed into a separate collection. However, do not use 75989 or any of the modality-specific guidance codes.

49999

Unlisted procedure, abdomen, peritoneum and omentum

If a catheter is not left in place for ongoing drainage, assign an unlisted code such as 49999.

49407

Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, transvaginal or transrectal

Assign code 49407 for catheter drainage of pelvic fluid collections accessed transvaginally or transrectally. One question some coders may have is whether this code should be submitted for each catheter placed. It is correct to report 49407 for each catheter placed. Do not assign 75989 or any of the modality-specific guidance codes.

If a catheter is not left in place for ongoing drainage, assign an unlisted code such as 49999. Guidelines in the CPT manual note that 10030 and 49405–49407 should not be reported for the following:

• percutaneous cholecystostomy tube placement,
• thoracentesis,
• pleural drainage,
• paracentesis,
• or tunneled abdominal drainage catheter placement.

Finally, these codes would also not be assigned for open drainage procedures.

These are not all the necessary coding tips and rationale essential for basic interventional radiology knowledge. As service volumes rebound, now more than ever, it is imperative to make sure your CPT® coding is correct and compliant. Master more interventional radiology topics and break down the complexity with our expert-infused 2023 Catheter-Based Drainage Interventional Radiology Coding webcast. This webcast is an essential training tool for both audio and visual learners.