2025 CPT code 49405
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Image-guided percutaneous drainage of fluid collection, abdomen or chest
Modifiers may be applicable to this code. For example, modifier 22 (Increased Procedural Services) may be used if the procedure is significantly more complex than usual, requiring additional time and resources. Modifier 59 (Distinct Procedural Service) may be used if 49405 is performed along with another procedure on the same day, but the two procedures are distinct and separate. It is important to check payer guidelines for specific modifier usage rules.
Medical necessity is established when the fluid collection is causing significant symptoms or poses a risk to the patient's health. This may include pain, fever, infection, organ dysfunction, or risk of rupture. Less invasive treatments should be considered before percutaneous drainage is performed, unless contraindicated or deemed ineffective.
The physician is responsible for preparing and sedating the patient, locating the fluid collection using imaging guidance, percutaneously inserting the drainage catheter(s), managing the catheter(s), and ultimately removing them. This may include post-procedure care and follow-up.
In simple words: The doctor uses imaging, like ultrasound or X-ray, to guide a needle through your skin and into a pocket of fluid in your belly or chest. A small tube (catheter) is then placed through the needle to drain the fluid. The doctor may need to place more than one tube. This procedure can be used to drain fluid from infections (abscesses), blood clots (hematomas), cysts, or other fluid build-ups. The doctor will also take care of the tube and remove it when it's no longer needed.
The provider performs image-guided percutaneous drainage as the initial therapy for a fluid collection in the abdomen or chest. After preparing and sedating the patient, the provider locates the fluid collection and uses imaging guidance to insert a catheter percutaneously (through the skin). This allows for continuous drainage of the fluid, which could be from an abscess, hematoma, lymphocele, cyst, or seroma. One or more catheters may be placed. The service may also encompass catheter maintenance and removal.
Example 1: A patient presents with an intra-abdominal abscess following a ruptured appendix. A CT scan confirms the abscess. Using ultrasound guidance, the physician performs a percutaneous drainage of the abscess, placing a catheter for continuous drainage., A patient develops a postoperative seroma after a kidney transplant. The physician uses imaging guidance to place a percutaneous drain to evacuate the seroma and promote healing., A patient with cirrhosis develops a large hepatic cyst causing discomfort. The physician utilizes CT guidance for a percutaneous drainage of the cyst, inserting a catheter for drainage.
Documentation should include the following: imaging reports confirming the presence and location of the fluid collection, type of imaging guidance used (e.g., ultrasound, CT, fluoroscopy), number of catheters placed, type and amount of fluid drained, any complications encountered, and confirmation of informed consent. Medical necessity for the procedure must be clearly documented, including the patient's symptoms, failed conservative treatments (if any), and the potential risks and benefits of the procedure.
- Specialties:Interventional Radiology, General Surgery, and other surgical specialties depending on the location of the fluid collection.
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, and other facilities where imaging guidance is available.