Correct coding for abscess drainage

Q.

CPT^® code 75989 is for abscess drainage. What needs to be documented to report 75989 instead of 49405–49407? The techs in the radiology department want to assign CPT code 75989 and coders say it should be 49405–49407. The exams are performed percutaneously.

A.

CPT code 75989 is an older radiological supervision and interpretation (S&I or RS&I) radiology code for when you were required to submit both the surgical code along with the S&I code for image-guided percutaneous abscess drainage. This was (and is) known as “Component Coding.” 

Currently, most likely, it will only be reported with CPT code 32550 – Insertion of indwelling tunneled pleural catheter with cuff. Because of collapsing or bundling of S&I and surgical portions of an exam into a single CPT code, the imaging is included in the surgical code for the drainage. Specifically, the CPT book says not to code submit CPT code 75989 with codes 10030, 32554, 32555, 32556, 32557, 33017, 33018, 33019, 47490, 49405, 49406, 49407.

Percutaneous abscess drainage is now reported with 10030, 49405–49407 if an indwelling catheter is left in place. These codes should be billed by both the hospital and the physician. If the catheter is removed at the end of the session, or if a needle is used for aspiration, then code 10160 or an unlisted code would be used. 

The primary reason you don’t want to choose 75989 if you are billing for the hospital is that it is packaged, and you won’t get any payment. The codes and full descriptions are as follows:

75989 Radiological guidance (i.e., fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (e.g., abscess, specimen collection), with placement of catheter, radiological supervision and interpretation

49405 Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); visceral (e.g., kidney, liver, spleen, lung/mediastinum), percutaneous

49406 Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous

49407 Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, transvaginal or transrectal

10030 Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst), soft tissue (e.g., extremity, abdominal wall, neck), percutaneous

10160 Puncture aspiration of abscess, hematoma, bulla, or cyst