Ultrasound Question for the Week of July 11, 2016

Question:

Question:

Our radiologists use ultrasound for guidance during paracentesis and thoracentesis but do not always save an image to the PACS (picture archiving and communication system). They do include ultrasound guidance in their dictation. Can we still bill CPT codes 32555 and 49083 for these without a saved image?

Answer:

Answer:

If permanent images are not kept, you must report the non-image-guided codes 32554 and 49082.

32554   Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance

49082   Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance

The surgery guidelines in the CPT book say the following: “When imaging guidance or imaging supervision and interpretation is included in a surgical procedure, guidelines for image documentation and report, included in the guidelines for Radiology (Including Nuclear Medicine and Diagnostic Ultrasound) will apply.”

The CPT ultrasound guidelines say: “Ultrasound guidance procedures also require permanently recorded images of the site to be localized, as well as a documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized.”

And CPT Assistant, March 2014, included this question and answer:

Question: Does code 49083, Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance, require a permanently recorded image?

Answer: Yes. As stated in the diagnostic ultrasound guidelines in the CPT code set, “Ultrasound guidance procedures also require permanently recorded images of the site to be localized, as well as a documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized.