Ask Dr. Z

Can you please advise correct coding? 49400, 74190 and 49999? The patient reports the catheter has been functioning well up until last week, at which time there began difficulty at withdrawing fluid. He presents today to Interventional Radiology for evaluation and repositioning, if indicated. Under fluoroscopy, the catheter was seen to loop upon itself in the left lower quadrant, with its tip projecting over the sacrum. Contrast injection with the catheter in this position outlined bowel loops in the left lower abdomen, and although contrast could be freely injected, none was able to be aspirated. Following this, a 0.035 glide advantage guidewire was introduced through the catheter, exiting the catheter tip, and with gentle advancement of the guidewire, the catheter tip was able to be repositioned such that it eventually projected over the iliac crest. Additional contrast injections comfirmed proper tip location and function." Please advise best coding for this case.