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:
If permanent images are not kept, you must report the following non-image-guided codes:
32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance
49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance
Also be aware of the following surgery guideline in the CPT book: “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.”