Basics of 
Paracentesis CPT code update
Abdominal paracentesis is done to remove the accumulated fluid in the abdomen cavity. The abnormal fluid in abdominal cavity is called ascites. Abdminal paracentesis is done majorly to remove ascites. Earlier we have to code Abdominal paracentesis along with imaging guidance. But, the new bundled codes are having imaging guidance included with them. Lets checkout the new Paracentesis cpt code.
49082 Abdominal Paracentesis without imaging Guidance (Diagnostic or therapeutic)
49083 Abdominal Paracentesis with imaging Guidance (diagnostic or therapeutic)
49084 Peritonal lavage, including imaging guidance, when performed.
CPT code 49084 is reported for diagnostic or therapeutic peritoneal lavage. A diagnostic peritoneal lavage is usually performed to confirm or reject suspected intra-abdominal bleeding (eg, in the setting of trauma). A therapeutic peritoneal lavage may be performed as a definitive treatment for inflammation or infection. In this procedure, a needle or catheter is inserted in the abdominal cavity, fluid is infused (eg, warm saline, antibiotic solution), which is then removed and submitted for analysis
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The main diagnosis ICD 10 code for Abdominal paracentesis is R18.8 (ICD 9 code 789.59) for ascites. This is main reason for performing paracentesis.
Medical Coders should report the CPT code 49084, to denote peritoneal lavage, including imaging guidance, when performed. This is an open procedure that physicians typically perform on acute unstable patients. Regarding Guidance codes, do use them carefully, since now we have CPT codes with and without guidance.
Ultrasonic guidance (CPT code 76942) for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
Fluoroscopic guidance (CPT code 77002) for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)
Computed tomography (CPT code 77012) guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation
Magnetic resonance guidance (CPT code 77021) for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation
Read also: How to become Expert in coding Imaging guidance
Points to Remember for coding abdominal Paracentesis CPT code
Do not code an imaging guidance code with 49083 and 49084, since it is always included with these cpt codes.
Do not report CPT 49083 in conjunction with CPT codes 76942, 77002, 77012 or 77021. Peritoneal lavage with imaging guidance is reported with 49084, when performed. Old CPT code 49080 and 49081 has been deleted.
Don’t confuse with diagnostic or therapeutic procedure, we can use these 49082 and 49083 with both of them.
If there is procedure done along with imaging guidance like ultrasound guidance 76942 and abdominal paracentesis is also done with imaging guidance 49083, do use a 59 modifier with 76942 to distinct it for the abdominal Paracentesis procedure. Because without assigning 59 modifier, the procedure won’t get paid.
Ultrasound localization at a session separate from the paracentesis procedure is reported with the limited ultrasound of the abdomen code 76705, Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up).
Paracentesis CPT code is very easy to apply as compared to surgery procedure codes. This will help is improving the quality of work in medical coding.
Paracentesis performed via the drainage catheter at the same setting as placement (CPT code 49406) is bundled and not reported.
If a patient returns two days later for a completely new, but repeat paracentesis (including placement of a new paracentesis catheter), use code 49082 or 49083 for this new date of service paracentesis procedure.
If subsequent paracentesis is performed via a drainage catheter that was previously placed, use an E&M code for this follow-up paracentesis via existing catheter (on a separate date of service) as appropriate.
Additional paracentesis performed at the same setting as an initial paracentesis is included and coded as one complete paracentesis. Report code 49083 once if imaging guidance used.
Use appropriate E&M code for removal of a non-tunneled abdominal drainage catheter as appropriate.