Ask Dr. Z

My radiologist wants to report both codes 49406 and 49803 for this procedure.  "The skin overlying a large collection of free fluid was marked and prepped and draped in the usual sterile fashion. A paracentesis needle was advanced into the collection with ultrasound guidance, and fluid return was obtained. Fluid was aspirated and sent for evaluation. The needle was removed. A 0.35 wire was advanced into the fluid. An 8.5 French pigtail drainage catheter was passed over the wire. The catheter was secured and connected to drainage bag. The patient tolerated the procedure well without immediate complication." Although they do not hit an NCCI edit, my gut is telling me that without documentation of a separate percutaneous puncture site I would not be justified in billing for both procedures. What are your thoughts? I feel uncomfortable coding both because the needle or catheter is removed at the completion of 49083, and the way this report is documented I do not see two separate procedures but just the placement of the drainage catheter with drainage of fluid.