Wiki 49421 Insertion of tunneled intraperitoneal cath. for dialysis, open

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I'm curious why ultrasound guidance would be needed for an open procedure. I can understand if done percutaneous (which would be bundled in 48418)
 
I don't know why the doctor wanted to charge a 49421, but I'm believe that this should be percutaneous, not open since you are asking that question. I believe that the correct code should be 49418 which is percutaneous and does include U/S. Do you agree?
 
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