Scenario:
A 64-year-old patient with new onset ascites presents for abdominal paracentesis. An ultrasound guided diagnostic and therapeutic paracentesis are both performed via a catheter. Is it appropriate to report two procedure codes for the diagnostic and therapeutic paracentesis?
Answer:
0W9G3ZZ – Drainage of peritoneal cavity, percutaneous approach, for the diagnostic and therapeutic paracentesis
Rationale:
In this particular situation, only one code is required. If there is a therapeutic component to the procedure, only the qualifier “Z” is used, rather than the qualifier “X”. The qualifier “X” is exclusively used for diagnostic procedures only. If there are two separate procedures, one diagnostic and the other therapeutic, then both procedures are coded separately. For example, a diagnostic drainage procedure that uses a different approach or samples a different site from the therapeutic drainage procedure requires two separate codes to capture both the diagnostic procedure (biopsy) and the therapeutic procedure. This logic can also be applied in the event of any similar drainage procedure performed and is described as “diagnostic and therapeutic”.
Reference:
Third Quarter 2017 Coding Clinic P. 12-13