peritoneal dialysis catheter


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Procedure: Ultrasound and fluoroscopically guided insertion of a
tunneled peritoneal paracentesis catheter

preliminary ultrasound was performed over the right and midline
abdomen, and a suitable large pocket of fluid was marked. An exit
site was also marked, approximately 7 cm from the marked puncture

The patient's abdomen was then double prepped and draped in the
usual sterile manner and locally anesthetized with lidocaine with
epinephrine. A 17 gauge guiding needle was used, advanced from
the catheter exit site to the region of the puncture site. A
curved 22 gauge Chiba needle was then advanced through the lumen
of the guiding needle, after a curved had been placed on the tip.
Using external compression the needle was then advanced out the
tip of the guiding catheter, and used to access the peritoneal
cavity. Appropriate peritoneal puncture was confirmed with
ultrasound. A permanent sonographic recording was created and
placed in the patient's medical record. A Cope guide wire was
advanced into the peritoneal cavity, documented looping in the

The entire tract was then dilated with an Inter-V triaxial
introducer set and an adjacent Amplatz wire was placed. The 4F
inner catheter was readvanced of the Cope guide wire, and
lidocaine without epinephrine was then injected, as the catheter
was withdrawn through the entire tract. Sequential dilatation was
then performed over the Amplatz wire, the puncture was dilated to
18 French, and the tunnel was dilated to 20 French. Via an 18
French peel-away sheath, the Tenckhoff catheter was advanced until
the subcutaneous cuff resides in the middle of the tunnel. The
peelaway sheath was removed, there was a rush of fluid from the
catheter. A purse string suture was then placed at the catheter
exit site in order to maintain catheter position as well as to
prevent leakage of ascites. A sterile dressing was applied. The
patient tolerated the procedure well, left the department in
stable condition.

Fifteen French Tenckhoff type tunneled peritoneal dialysis
catheter placed using single stick technique. No immediate
complications. Patient given follow-up appointment for removal of
the skin sutures.

Can we code CPT 49421 & 75989-26 for the above procedure.Pls confirm.