CPT 2011 Freshens Up Your IP Catheter Coding Choices

Published: 30th March 2011
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For intraperitoneal (IP) catheter coding, confusing terms such as 'temporary' and 'permanent' are archaic now. Read on and find out how CPT 2011 freshens up your options:

Just-in code 49418 begins the IP catheter code changes

Defined as a 'complete' procedure, you will find multiple services covered by the just-in code 49418. Medicare assigned this code a 0-day global period, meaning Medicare does not bundle visits on subsequent days into the procedure payment.

Tread carefully: Medicare's national fee schedule prices for 49418 vary considerably based on whether you are reporting a facility service ($234.78) or non-facility service ($1,519.08). This is a difference of more than $1,200; therefore you should make it a point to watch your place of service code.

Rectify the codes listed in 49419's line note

On the whole, changes demonstrate the 'coding lag' that occurs in keeping up with advances in new surgical procedures. As a matter of fact, the addition of 49418 is part of a larger reworking of tunneled intraperitoneal (IP) catheter codes to bring them in sequence with present practice. To begin with, CPT revises 49419:

  • Last year: 49419-- Insertion of intraperitoneal cannula or catheter, with subcutaneous reservoir, permanent (that is., totally implantable)

  • This year: 49419 -- Insertion of tunneled intraperitoneal catheter, with subcutaneous port (that is totally implantable).

    Why: By referencing subcutaneous port, the code language reflects the present technology. What's more, CPT removed the term "cannula" since physicians normally carry out these procedures using a catheter only.

    According to AMA's published errata, you will need to rectify the CPT manual note following 49419. The note should read as here: (changes underlined): "49420 has been deleted." In order to report open placement of a tunneled peritoneal catheter for dialysis, code 49421. Whereas to report open or percutaneous peritoneal drainage or lavage, see 49020, 49021, 49040, 49041, 49080, 49081, as proper. To report percutaneous insertion of a tunneled peritoneal catheter minus subcutaneous port, go for 49418.

    Among other code changes, focus on 49422

    Other changes pertaining to IP catheter coding include the following:

    According to the Symposium presentation, these changes are part of an endeavor to 'clean up' codes that overlapped and caused confusion. For instance, the terms temporary and permanent (used last year) caused confusion over whether they referred to placement or to device itself. What's more, CPT 2011 added the term 'tunneled' to acknowledge the subcutaneous channel in which the doctor places the catheter.

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

    Instruction: You should not miss the note with 49422. This code is only for removal of a tunneled catheter. If the doctor removes a non-tunneled IP catheter, CPT guides you to report the proper E/M code.

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