June 23, 2017

ACR Successful in Revision of Abscess Drainage and Liver Biopsy Code Edit

The Centers for Medicare and Medicaid Services (CMS) notified the American College of Radiology (ACR) that it will revise the procedure-to-procedure edit for the column one CPT code 49405 (Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); visceral (e.g., kidney, liver, spleen, lung/mediastinum), percutaneous) and column two CPT code 47000 (Biopsy of liver, needle; percutaneous). CMS will modify this edit in the Oct. 1, 2017 version of the National Correct Coding Initiative (NCCI) to allow use of an NCCI-associated modifier for situations where the procedure described by CPT code 49405 is performed and a separate diagnostic percutaneous needle biopsy of the liver at a different site is also performed.

The ACR and Society of Interventional Radiology (SIR) appealed the code pair edit 49405/470000 with a modifier indicator of “0”, which did not allow the code pair to be reported by the same physician for the same patient on the same date of service.

The ACR and SIR argued that a percutaneous liver biopsy (47000) is not inherent to the entirety of an abscess drainage (49405) procedure. The Relative Value Scale Update Committee (RUC) database intra-service work for 49405 notes fluid is aspirated and sent for laboratory analysis as part of the procedure (note this describes a fine needle aspiration (FNA) biopsy and not a core biopsy). FNA biopsy and core biopsy are different procedures as the former involves aspiration of cells, while the latter corresponds to removal of a solid core sample of tissue. The ACR and SIR requested that a modifier indicator of “1” be assigned to allow the use of a modifier to bypass the edit. This will give practices the ability to report both codes on the same day when it is in the best interest of the patient.