Radiology Question for the Week of July 29, 2024

Question:

A physician ordered an ultrasound study to check for abdominal ascites and asked the skin be marked if the ultrasound study is positive. The ordering physician, subsequently, did the paracentesis procedure at the bedside “without” imaging guidance based on the skin markings. How are these studies reported?

Answer:

It would be appropriate for the physician who performed the ultrasound to check for ascites localization and mark the skin for a paracentesis procedure to report a limited abdominal ultrasound (code 76705, Ultrasound, abdominal, real time with image documentation; limited). The physician who performed the paracentesis utilizing the localization markers should report the “without guidance” code, code 49082, Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance. Typically, when paracentesis is performed with ultrasound image guidance, the guidance is performed contemporaneously and by the same physician performing the paracentesis. In this case, only code 49083, Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance, should be reported. (Source: Clinical Examples in Radiology, Volume 8, Issue 2; Spring 2012)

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