Cpt 2011: IP Catheter Code Changes

For intraperitoneal (IP) catheter coding, confusing terms such as 'temporary' and 'permanent' are a thing of the past. Here's how CPT 2011 freshened up your options:

New code 49418 begins the IP catheter code changes

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

Medicare assigned this just-in code a 0-day global period, which means Medicare does not bundle visits on subsequent days into the procedure payment.

Progress 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 is a difference of more than $1,200; as such be sure to watch your place of service code.

Rectify the codes listed in 49419's line note

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

2010: 49419

2011: 49419

Here's why: By referencing subcutaneous port, the code language reflects present technology.

What's more, CPT removed the term 'cannula' as doctors commonly carry out these procedures using a catheter only.

According to AMA's published errata: You will require correcting the CPT manual note following 49419. The note should read as follows: 49420 has made an exit. To report open placement of a tunneled peritoneal catheter for dialysis, report 49421. To report open or percutaneous peritoneal drainage or lavage, take a look at 49020, 49021, 49040, 49041, 49080, 49081 as proper. To report percutaneous insertion of a tunneled peritoneal catheter without subcutaneous port, go for 49418.

Among other code changes, focus on 49422 note

Other changes related to IP catheter coding include the following:

According to the symposium, these changes are part of an attempt 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 the device itself. That apart, CPT 2011 added the term 'tunneled' to acknowledge the subcutaneous channel in which the physician places the catheter.

Exit: See to it that you catch that this year's CPT deleted 49420. The revisions and additions of other, more specific codes made 49420 obsolete.

Vital instruction: Do not miss the note with 49422. This code is for removal of a tunneled catheter only. If the physician removes a non-tunneled IP catheter, CPT guides you to use the proper E/M code.

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