General Surgery Coding Alert

Question: A surgeon places a peritoneal dialysis catheter (49421) and at the completion of this surgery, he infuses and extracts a liter of fluid to assess the patency of the catheter and to ensure the abdominal cavity is of adequate size to ensure a proper dialysis treatment. Can we bill a peritoneal lavage for this process (49080) at the same setting with the catheter insertion?

Pennsylvania Subscriber

Answer: No, you should not report 49080 (Peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; initial). That code is for percutaneous peritoneocentesis, not for lavage (or any other type of fluid instillation into the abdomen) during another procedure.

Bottom line: The peritoneal lavage is not separately codeable with the catheter placement (49421, Insertion of intraperitoneal cannula or catheter for drainage or dialysis; permanent). The lavage was basically just the surgeon checking his work and is part of the procedure.