Copyright 2023 Radiological Society of North America, Inc. (RSNA). Preparation Without Contrast: No preparation is required. CPT code 49082 describes an abdominal paracentesis (diagnostic or therapeutic) without imaging guidance. . Storm AC, et al. W]jykgH`Gxy`o_>4 lD,J5mV/xO=1Z~zZcbm) E(? Pancreatic fistula is one of the most severe and common complications following distal pancreatectomy. Ywk(JCfH,! +"\4:=^ KRze%&#FN)c\TmdXikkCPt Dl[`G \`ymA4w I 7lZ~u Dorrell R, Pawa S, Pawa R. Endoscopic management of pancreatic fluid collections. Indications for percutaneous drainage are broad: essentially any abnormal fluid collection in the patient which can be accessible. You will feel a slight pinch when the nurse inserts the needle into your vein for the IV line and when they inject the local anesthetic. contrast materials. CPT code 49082, 49083, 49084 - abdominal paracentesis The patient is explained the risks, benefits, and alternatives of the procedure abdominal paracentesis for treatment of her malignant ascites. It is an established procedure with a high success rate 1. Results: After exclusion of 14/300 (4.6%) patients who were not on empiric antibiotics and 8/300 (2.6%) patients in which no culture was acquired, 278 patients (average age 5516years; M:F ratio 54:46) constituted the final study cohort. Article The chance of infection requiring antibiotic treatment appears to be less than one in 1,000. The patient's basic vital signs should be monitored for 4 hours post procedure (pulse, blood pressure, SpO2), or as long as deemed necessary. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in [Endoscopic management of complications in the hepatobiliary and pancreatic system and the tracheobronchial tree]. Examples include: complicated appendicitis with appendicular abscess, hepatic abscess (e.g. Patient imaging and clinical characteristics were evaluated by an abdominal imaging fellow and culture results, and patient management were evaluated by an infectious diseases fellow. Ultrasound machines consist of a computer console, video monitor and an attached transducer. Purpose: The purpose of the study was to evaluate diagnostic yield and the added value of culture results on the clinical management of patients empirically treated with antibiotics prior to CT-guided drainage. Surg Clin North Am 81(399403):xii. The pancreatic parenchyma revealed a lobulation, stranding, foci, and an irregular pancreatic duct consistent with chronic pancreatitis. Bookshelf Lin L F, Tung J N. Difficult endoscopic retrieval of a migrated stent inside a pseudocyst. This site needs JavaScript to work properly. (2012) ISBN: 9781931884860 -. Gastrointest Endosc. List any allergies, especially to local anesthetic, The radiologist uses ultrasound images to help guide the drainage catheter to the area of fluid collection. Background/purpose: Endoscopic ultrasound-guided drainage (EUS-GD) of postoperative abdominal fluid collections (POFC) following pancreatic surgery is used as an alternative or complement to percutaneous drainage (PD) procedure. Yang J, Kaplan JH, Sethi A, et al. Chhabra P, Maher B, Trivedi D, Karavias D, Arshad A, Wright M, Tehami N. Ann Hepatobiliary Pancreat Surg. 2022 Jun;36(6):3708-3720. doi: 10.1007/s00464-022-09137-6. Management of clinically relevant postoperative pancreatic fistula-related fluid collections after distal pancreatectomy. and transmitted securely. US-GUIDED PROCEDURE CPT CODENOTES wRVU 2020 US-GUIDED THORACENTESIS 32557 Thoracentesis and catheter placement. Mayo Clinic researchers have published their experience providing patients with minimally invasive internal drainage of postoperative fluid collections, whereby the collection is drained with one or more stents into the stomach or small intestine, rather than through the skin. %PDF-1.3 2 2. Other Policies and Guidelines may apply. New York. These fluid collections can cause significant symptoms, including pain, nausea and the inability to eat, or signs of infection including fever and abnormally low blood pressure. Cultures were positive in 205/278 (74%) patients with a resulting change in management in 181/278 (65%) cases. 236/278 (85%) received drains and the remainder were aspirated only. Specifically, the CPT book says not to code submit CPT code 75989 with codes 10030, 32554, 32555, 32556, 32557, 33017, 33018, 33019, 47490, 49405, 49406, 49407. Occasionally, CT-guidance will be used. Percutaneous abscess drainage is now reported with 10030, 4940549407 if an indwelling catheter is left in place. Three-color marking method to prevent stent migration in endoscopic ultrasound-guided draining for peripancreatic fluid collections. There is a very slight risk of an allergic reaction if the procedure uses an injection of. Epub 2013 Jan 30. @[WH2bkaR|_: } IGt9VYN0LX!^Tty{)R^IOv5 9^=7%#!2DT9n? The upper tract consists of the esophagus, stomach and duodenum; the lower tract includes the colon and rectum. Cystogastrostomy; EUS-guided drainage; Early drainage; Postoperative abdominal fluid collection; Stent. Gut. no financial relationships to ineligible companies to disclose. Occasionally, abscesses that cannot be treated by percutaneous drainage may require surgical drainage in the operating room. Ultrasound guided percutaneous drainageis one form of image guided procedure, allowing minimally invasive treatment of collections that are accessible by ultrasound study. You should plan to stay overnight at the hospital following your procedure. note = "Publisher Copyright: {\textcopyright} 2016, Springer Science+Business Media New York. It is an established procedure with a high success rate PDF EMERGENCY ULTRASOUND CODING GUIDE 2018 - American College of Emergency the contents by NLM or the National Institutes of Health. Very rarely, an adjacent organ may be damaged by percutaneous abscess drainage. Your doctor will numb the area with a local anesthetic. This study assessed the efficacy and safety of the early drainage (< 4 weeks) of PAFCs via EUS guidance. 1 E-Videos Gastrointest Endosc. J Surg Res. general anesthesia, or Alternatively, large volume paracentesis (removal of up to 6 liters of fluid) may be performed for therapeutic purposes. Endoscopic ultrasound-guided transmural drainage of postoperative pancreatic collections. FNA is usually done in the breast, thyroid gland or lymph nodes in the neck, groin, or armpit. It has several advantages and disadvantages over CT, which include: Advantages is a dynamic study, allowing greater precision to control needle insertion Paracentesis may be performed for diagnostic purposes, in which case only a small amount of fluid is removed. To evaluate clinical outcomes following transvaginal catheter placement using transabdominal ultrasound guidance for management of pelvic fluid collections. It may take several days for all the fluid to be removed. Conclusions: {"url":"/signup-modal-props.json?lang=us"}, Hameed A, Murphy A, Baba Y, et al. Image-guided, minimally invasive procedures such as percutaneous abscess drainage are most often performed by a specially trained interventional radiologist in an interventional radiology suite or under CT guidance in a separate area of the radiology department. The individuals who appear are for illustrative purposes. PDF 2023 PROCEDURES CPT CODES - depts.washington.edu To help ensure current and accurate information, we do not permit copying but encourage linking to this site. 8600 Rockville Pike Adverse events associated with endoscopic ultrasound drainage were all mild or moderate in severity, including post-procedure vomiting, one stent maldeployment that was simply replaced, and the aforementioned fluid re-accumulation after stent removal in five patients who then underwent a repeat endoscopic drainage procedure. This page was reviewed on April, 15, 2022. Bethesda, MD 20894, Web Policies Please enable it to take advantage of the complete set of features! CT The CT scanner is typically a large, donut-shaped machine with a short tunnel in the center. }r v5B{Ev;v%JeX! +yz"zD}W~j;V;Hh9l]nr. (,UpLo7tsPHE4B@AZn!i? To report open or percutaneous peritoneal drainage or lavage, see 49020, 49021, 49040, 49041, 49082-49084, as appropriate. Keywords: 2014 Jan;218(1):33-40. doi: 10.1016/j.jamcollsurg.2013.09.001. This was (and is) known as Component Coding.. Endoscopic Ultrasound (EUS) Drainage of Pancreatic - Find-A-Code Little is currently known, however, regarding the EUS-guided drainage of PAFCs of less than 4 weeks. When most of the fluid has drained, the tube will be removed. Several factors were found to be statistically significant predictors of positive cultures: patient leukocytosis (sens 62%, spec 53%), gas in the collection on CT (sens 59%, spec 77%), purulent material aspiration (sens 76%, spec 76%), and presence of polymorphonuclear cells in the specimen. However, in a personal communication, the following direction was shared: To assign any of the above codes, the patient undergoing the imaged-guided percutaneous fluid collection must leave the area (i.e., angiography lab) where the procedure was performed with an indwelling catheter left in place. The base of the proximal pigtail originally had a black marker, making three colored marks ( The left side is the stent insertion direction. 1995;36(3):437-41. left ventricular systolic and diastolic function, ultrasound-guided musculoskeletal interventions, gluteus minimus/medius tendon calcific tendinopathy barbotage, lateral cutaneous femoral nerve of the thigh injection, common peroneal (fibular) nerve injection, metatarsophalangeal joint (MTPJ) injection. Complete blood count: platelet count > 50000/mm3 (Some institutions determine other values between 50000-100000/mm3) 1, international normalized ratio (INR) 1.5 1, normal prothrombin time (PT), partial thromboplastin time (PTT). * Code 49082 describes an abdominal paracentesis performed without imaging guidance. [Show full abstract] and intervention outcomes of 53 patients who underwent drainage procedure (EUS-guided, n = 32; PCD, n = 21) for fluid collection after PD between January 2015 and June 2019 in . abstract = "Purpose: The purpose of the study was to evaluate diagnostic yield and the added value of culture results on the clinical management of patients empirically treated with antibiotics prior to CT-guided drainage. Video1 This section has its own submission website at 2013 Jul;27(7):2422-7. doi: 10.1007/s00464-012-2752-z. After that, a 6Fr endoscopic nasocystic drain was placed ( 2021;10(2):284. Methods: This retrospective, HIPAA-compliant, IRB-approved study reviewed records of 300 consecutive patients who underwent CT-guided aspiration or drainage for suspected infected fluid collection while on empiric antibiotics (11/2011 to 9/2013) at a single institution. J Gastrointest Surg 15:13271328 On musculoskeletal ultrasound, the diagnosis of a Baker's cyst can be established by identification of a popliteal cystic lesion, with a fluid-containing neck between the tendon of semimembranosus and medial head of gastrocnemius. The entry site should be reviewed on a daily basis. Fig. A blue marker was added to the base of the distal pigtail and a red marker was placed to the middle of the stent with a permanent marker. It is about 1/8 inch in diameter. Acute and early EUS-guided transmural drainage of symptomatic postoperative fluid collections. G=#b)!.XL@@$? The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously. stream The catheter placed at the time of percutaneous abscess drainage may become blocked or displaced requiring manipulation or changing of the catheter. Postoperative abdominal fluid collections (PAFCs) are a potentially fatal complication of pancreatobiliary surgery. Average time between initiation of antibiotics and start of the drainage procedure was 4.16.4days (median 1.7days). Percutaneous abscess drainage is generally used to remove infected fluid from the body, most commonly in the abdomen and pelvis. Effectiveness of early endoscopic ultrasound-guided drainage for postoperative fluid collection Surg Endosc . and transmitted securely. This may briefly burn or sting before the area becomes numb. The computer creates the image based on the loudness (amplitude), pitch (frequency), and time it takes for the ultrasound signal to return to the transducer. Most of the sensation is at the skin incision site. Avoiding a drainage tube through the skin for patients with Tllez-vila F, Carmona-Aguilera GJ, Valdovinos-Andraca F, Casasola-Snchez LE, Gonzlez-Aguirre A, Casanova-Snchez I, Elizondo-Rivera J, Ramrez-Luna M. Clinical success, defined as resolution of the fluid collection without recurrence on follow-up imaging, was achieved in 70 patients (93%), with five patients who had a recurrence of their collection again treated with endoscopic ultrasound-guided internal drainage with ultimate resolution of their fluid collection. Tilara A, Gerdes H, Allen P, Jarnagin W, Kingham P, Fong Y, DeMatteo R, D'Angelica M, Schattner M. J Am Coll Surg. Outside links: For the convenience of our users, RadiologyInfo.org provides links to relevant websites. A red mark meaning stent center, form distal pigtail was placed in the middle of the stent with a permanent marker. Kwon YM, Gerdes H, Schattner MA, Brown KT, Covey AM, Getrajdman GI, Solomon SB, D'Angelica MI, Jarnagin WR, Allen PJ, Dimaio CJ. 1. ULTRASOUND-GUIDED DRAINAGE CATHETER PLACEMENT History: Recurrent right perirenal fluid collection. title = "Diagnostic yield and clinical impact of microbiologic diagnosis from CT-guided drainage in patients previously treated with empiric antibiotics". sharing sensitive information, make sure youre on a federal All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. An abscess is an infected fluid collection within the body. Cultures were positive in 205/278 (74%) patients with a resulting change in management in 181/278 (65%) cases. Epub 2013 Oct 5. 2022 Oct 21. doi: 10.1007/s00104-022-01735-3. This case presentation demonstrates the feasibility of this technique in a patient with Roux-en-Y anatomy. A catheter is a long, thin plastic tube that is considerably smaller than a "pencil lead." Kwon YM, Gerdes H, Schattner MA, Brown KT, Covey AM, Getrajdman GI, Solomon SB, D'Angelica MI, Jarnagin WR, Allen PJ, Dimaio CJ. Following large volume paracentesis the patient may receive an albumin infusion to prevent electrolyte imbalance. In general, the shortest possible route is preferred, as long as it does not traverse other structures. Careers, Unable to load your collection due to an error. Diana Jiang has no conflict of interest. However, you will not feel serious discomfort. By confirming the three colored marks, the stent could be deployed safely. Image-Guided Drainage | MUSC Health | Charleston SC It is most often performed for ascites, which is an abnormal accumulation of peritoneal fluid caused by liver disease, cancer or other conditions. The breast radiologist then places a small needle directly into the cyst and withdraws fluid. Copyright 2022 Bracco Diagnostics Inc. US-CG-2100022 10/21. Patient imaging and clinical characteristics were evaluated by an abdominal imaging fellow and culture results, and patient management were evaluated by an infectious diseases fellow. This procedure may use other equipment, including an intravenousline (IV), ultrasound machine and devices that monitor your heart beat and blood pressure. This can result in the development of symptomatic postoperative fluid collection requiring drainage. After dilation using a 4-mm balloon (REN biliary balloon catheter; KANEKA, Osaka, Japan), a double-lumen catheter (uneven double-lumen cannula; PIOLAX, Tokyo, Japan) was inserted and a second guidewire was placed. Several factors were found to be statistically significant predictors of positive cultures: patient leukocytosis (sens 62%, spec 53%), gas in the collection on CT (sens 59%, spec 77%), purulent material aspiration (sens 76%, spec 76%), and presence of polymorphonuclear cells in the specimen. if they are pregnant. In this procedure, ultrasound, CT, or x-ray equipment may be used to guide a needle into the fluid within the pleural space. Before Management of infected post-pancreatic resection fluid collections under endoscopic ultrasound guidance using lumen apposing metal stent: A case series and review of the literature. The codes specific to fluid drainage (10030, 49405, 49406, and 49407) require an indwelling . Unable to load your collection due to an error, Unable to load your delegates due to an error. Epub 2013 Jan 30. Online ahead of print. Safety and efficacy of the use of lumen-apposing metal stents in the management of postoperative fluid collections: a large, international, multicenter study. The doctor or nurse will remove your IV line before you go home. This three-color marking method is cheap, easy, and anyone can use it. VuJN(sB>st\xEh[dEP%b%D7M I eh|>]/q+< HSI$H1OwjqgNB1#t{'l_+$2Q%>CNe./Svn Aq m=}\A"\lH]@Q.k }jiuWtUBPeAo%2 O>G[ 2020;91:1085.e1. Report the following codes: 19301, Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); 38525, Biopsy or excision of lymph node (s); open, deep axillary node (s); +38900, Intraoperative identification (eg, mapping) of sentinel lymph node (s) includes injection of non-radioactive dye, when performed (List separately in In the case of ultrasound, direct visualization of the needle being inserted into the abscess is performed. There was no difference in success or risk of adverse outcome between patients undergoing drainage within 30 days from surgery compared with those undergoing drainage more than 30 days from surgery. The computer workstation that processes the imaging information is in a separate control room. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-21172. Skip navigation. The multiple step technique utilizes the modified Seldinger technique, whereby the abscess is entered with an introducer needle, through which a stiff wire is passed. These codes should be billed by both the hospital and the physician. ", "A prospective study evaluating endoscopic ultrasound-guided drainage of postoperative fluid collections as compared with percutaneous, or draining through the skin, would potentially be the next step in validating this retrospective study," said Dr. Storm. We developed a novel three-color-marking method to prevent stent migration. Conclusions: Despite predrainage antibiotic therapy, CT-guided drainage demonstrates a high yield of positive cultures and influences clinical management in the majority of patients. The median period from surgery to EUS-guide drainage was 14 days (Interquartile range [IQR] 10-16), and median time to resolution was 23.5 days (IQR 8.5-33.8). Unable to process the form. Methods: L6-QY{4@ Professionals; . Please reach out and we would do the investigation and remove the article. Doctors will not perform many tests during pregnancy to avoid exposing the fetus to radiation. PMC The gel allows sound waves to travel back and forth between the transducer and the area under examination. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The ultrasound image is immediately visible on a video monitor. % Finding Medicare fee schedule HOw to Guide, Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee, LCD and procedure to diagnosis lookup How to Guide, Medicare claim address, phone numbers, payor id revised list, Medicare Fee for Office Visit CPT Codes CPT Code 99213, 99214, 99203. Bethesda, MD 20894, Web Policies Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Effectiveness of early endoscopic ultrasound-guided drainage for *7 h? q[X3 You will lie on a narrow table that slides in and out of this short tunnel. Methods: This retrospective, HIPAA-compliant, IRB-approved study reviewed records of 300 consecutive patients who underwent CT-guided aspiration or drainage for suspected infected fluid collection while on empiric antibiotics (11/2011 to 9/2013) at a single institution. PDF Emergency Ultrasound Coding Guide 2020 Conclusions: Despite predrainage antibiotic therapy, CT-guided drainage demonstrates a high yield of positive cultures and influences clinical management in the majority of patients. Leukocytosis was present in 163/278 (59%), and fever in 65/278 (24%). If CT is used for guidance, CT scans are obtained intermittently to ensure that the needle is in the correct location. Jiang, D., Pawa, R. Endoscopic Ultrasound-Guided Drainage of a Postoperative Fluid Collection in the Setting of Roux-en-Y Anatomy. A rare but serious complication of stent migration has been reported "We are excited to offer this minimally invasive procedure to our patients who have just undergone some of the biggest and most difficult surgeries that are performed in our specialty, including Whipple and partial pancreatectomy, to help them recover without the need for external drains or bags," said Andrew C. Storm, M.D., lead author and member of the Mayo Clinic advanced endoscopy team in Rochester, Minnesota. Percutaneous Abscess Drainage - Medscape If the procedure uses sedation, you will feel relaxed, sleepy, and comfortable. Biopsies are coded to the root operations excision, extraction, or drainage (with the qualifier diagnostic). To locate a medical imaging or radiation oncology provider in your community, you can search the ACR-accredited facilities database. The average collection size was 8.54.2cm with gas present in 140/278 (50%) of collections; median amount drained was 35mL, and visibly purulent material was obtained in 172/278 (63%). National Library of Medicine s'S= 2022 Nov 10. doi: 10.1007/s00464-022-09713-w. Online ahead of print. 4kDBm{z+5+?wW7FTybirR9=8EnxJ wTVeD7N^;rOJ,0ONh~ Avoiding a drainage tube through the skin for patients with postoperative abdominal fluid collections. Average time between initiation of antibiotics and start of the drainage procedure was 4.16.4days (median 1.7days). Use code 10160 for needle drainage of fluid collection for therapeutic purposes. The change in management included change of antibiotics in 71/278 (26%), narrowing the antibiotic regimen in 94/278 (34%), and cessation of antibiotics in 16/278 (6%). Acute and early EUS-guided transmural drainage of symptomatic postoperative fluid collections. What will I experience during and after the procedure? Endoscopic ultrasound (EUS)-guided drainage using a plastic stent for peripancreatic fluid collections has been widely performed. They will sterilize and cover this area with a surgical drape. Results: After exclusion of 14/300 (4.6%) patients who were not on empiric antibiotics and 8/300 (2.6%) patients in which no culture was acquired, 278 patients (average age 5516years; M:F ratio 54:46) constituted the final study cohort. %X}$V,CNw|"^G,j+A\`kQ[LIa'uE>K#ER &[#lqHK4S$8#WzL@`_. Epub 2015 Apr 30. *_4ftv^[B]_{cbXQ m *5>KgX 4j0r ULTRASOUND GUIDED PROCEDURE (LEAVING A CATHETER IN PLACE) CODES 2017 US-GUIDED PROCEDURE CPT CODE NOTES wRVU 2017 US-GUIDED THORACENTESIS 32557 Thoracentesis and catheter placement. The indications of procedure included abdominal pain (n = 27), fever (n = 18), leukocytosis (n = 2), and increased size of PAFC during external tube drainage (n = 1). Methods: This retrospective, HIPAA-compliant, IRB-approved study reviewed records of 300 consecutive patients who underwent CT-guided aspiration or drainage for suspected infected fluid collection while on empiric antibiotics (11/2011 to 9/2013) at a single institution. Ultrasound guided percutaneous drainage may be performed with a single or multiple stage technique. x]]6-n]X=;#|#.TR>CT*eee~VV>vGgNM}8lWm;mWS?Z7_Sfcec_?v/T?xY7m|M_wK!@IAwjiUFBf:aZoY!+aYZFU_?#w_5_vuP%?Mm+77uznjyo[[(2mwR#mWm}*HomCdZ5/_q/K]+WIKNEauN&P6UB;n2! Cronin CG, Gervais DA, Castillo CF, Mueller PR, Arellano RS. * Limited sonography for localization of fluid is bundled. OBES SURG (2023). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA, Department of Medicine, Division of Gastroenterology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA, You can also search for this author in official website and that any information you provide is encrypted If a patient has these symptoms, it is not uncommon that they will undergo an imaging test, (usually a CT scanor an ultrasound), to assist in identifying and making the correct diagnosis of an abscess. 2(#kQ,xne}KL3qaDp3cVjH0MsdC=VQ'Bin (tv=@q~/`pY9 8rWWMg)V-m_B/ISW5}T\(0uF\]a1eU\+YC48MS ^PXfA}1-rM=Q6A>kHbyUpLd;g])t\}3*765ASyR}7qop Kathryn L. McGillen, Johannes Boos, Ruvandhi Nathavitharana, Alexander Brook, Maryellen R. Sun, Bettina Siewert, Vassilios Raptopoulos, Robert Kane, Robert Sheiman, Olga R. Brook, Research output: Contribution to journal Article peer-review. The change in management included change of antibiotics in 71/278 (26%), narrowing the antibiotic regimen in 94/278 (34%), and cessation of antibiotics in 16/278 (6%). Patient has WC and Medicare insurance? Bethesda, MD 20894, Web Policies Stent Occlusion (blockage) - There is a risk that the stent could become blocked, preventing drainage of fluid collection. 236/278 (85%) received drains and the remainder were aspirated only. Method: We included consecutive cases with POFC treated by EUS-GD between September . The https:// ensures that you are connecting to the MeSH Surg Endosc. The costs for specific medical imaging tests, treatments and procedures may vary by geographic region. <i>Methods</i>. The technologist applies a small amount of gel to the area under examination and places the transducer there. This is a preview of subscription content, access via your institution. The catheter will remain in place until the fluid has stopped draining and your infection is gone.
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ultrasound guided drainage of fluid collection cpt code