CPT 49083: Ultrasound-Guided Abdominal Paracentesis with Drainage

CPT 49083 – Abdominal paracentesis (diagnostic or therapeutic) with imaging guidance.

Code Components

• Includes: US guidance, needle/catheter insertion, fluid aspiration, imaging supervision/interpretation.
• Do not separately report US guidance (76942) or diagnostic paracentesis (49082) – bundled.

Indications

• New-onset ascites (diagnostic: cell count, albumin, culture, cytology).
• Symptomatic tense ascites (therapeutic: large-volume removal >5 L with albumin replacement).
• Suspected SBP (spontaneous bacterial peritonitis).

Billing Nuances

• If only diagnostic tap without imaging → 49082.
• If therapeutic drainage >5 L → may add albumin infusion (96365) separately.
• Modifier -59 if distinct from other procedure same day.

Key Documentation

• Volume removed, fluid appearance, US images saved, albumin given (if >5 L).
• Indication linking to diagnosis (e.g., cirrhosis, malignancy, heart failure).

Ultrasound guidance reduces complications (bowel perforation, vascular injury) and is standard of care.