Diagnostic vs. Therapeutic Paracentesis

A radiologist performs both a diagnostic and a therapeutic paracentesis on a patient with newly diagnosed ascites.  Should we assign two ICD-10-PCS codes in order to capture both the diagnostic and therapeutic components of this case?  This installment of “In the kNOW” will provide the answer and rationale.

At first glance, it appears that we should assign two ICD-10-PCS codes:
 
0W9G3ZX    Drainage of peritoneal cavity, percutaneous approach for the diagnostic paracentesis
0W9G3ZZ    Drainage of peritoneal cavity, percutaneous approach for the therapeutic paracentesis

However, the 3rd Qtr. 2017 Coding Clinic has provided guidance that instructs coders that the therapeutic component of the procedure would take precedence and to only assign the code for the therapeutic procedure.  Therefore, 0W9G3ZZ is the only code necessary when both a diagnostic and therapeutic paracentesis are performed at the same time.

It should be noted that the qualifier “X” is to be used solely for diagnostic procedures.
 
Obviously, two codes could be assigned if there are separate procedures performed: one diagnostic, one therapeutic.  When might that occur you ask?  Well, it could be if the same procedure had two different approaches, then you could have a diagnostic and a therapeutic procedure.  Or perhaps the diagnostic part of the procedure was performed at a different site.  Again, that would be an acceptable reason to have both diagnostic and therapeutic procedures coded.

Let’s look at an example.  A patient comes in for a biopsy of his left pleural cavity via thoracentesis.  Additionally, during the same episode, he is undergoing a therapeutic thoracentesis from the right side of his chest.  In this circumstance, we would assign the following codes:

0W9B3ZX    Drainage of left pleural cavity, percutaneous, diagnostic
0W993ZZ    Drainage of right pleural cavity, percutaneous


Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.