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Thread: tunneled peritoneal paracentesis

  1. #1

    Default tunneled peritoneal paracentesis

    AAPC: Back to School
    How to code US AND FLUORO guidance for this procedure,Is the procedure code 49420 please confirm.
    Procedure: Ultrasound and fluoroscopically guided placement of a
    tunneled peritoneal paracentesis catheter (Tenckhoff catheter).

    Clinical history:

    53-year-old male with advanced, endstage liver cirrhosis and
    intractable large volume ascites, requiring frequent large volume
    paracentesis. Referred for placement of a tunneled Tenckhoff type
    catheter, so that patient can drain his ascites at home as


    Initially the procedure was discussed at length with the patient
    including risks benefits and alternatives. Risks discussed
    included but were not limited to bleeding, infection,
    intra-abdominal organ and bowel injury, peritonitis etc.. The
    patient appeared to understand, asked appropriate questions and
    signed informed consent. Procedure duration was one hour.
    Intravenous versed and Fentanyl were administered for conscious
    sedation and analgesia, monitored by the interventional radiology
    nurse. 1.0 minutes fluoroscopy time.

    The patient received IV antibiotics prior to the procedure.
    Preliminary ultrasound was performed over the right lower quadrant
    and infraumbilical region, and a suitable large pocket of fluid
    was marked over the right infraumbilical region. An exit site was
    also marked, approximately 7 cm from the marked puncture site.

    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 20 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. Confirmation of needle positioning was confirmed with
    sonography, and a permanent sonographic recording was created for
    the patient's medical record. A Cope guide wire was advanced into
    the peritoneal cavity, documented looping in the abdomen.

    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. The patient's ascites was then
    drained, yielding approximately 8 L of clear, straw-colored fluid
    and sterile dressing applied. The patient tolerated the procedure
    well, left the department in stable condition.


    15 French Tenckhoff tunneled peritoneal paracentesis catheter
    placed using single stick technique. No immediate complications.
    Patient given instructions on using catheter to drain ascites at
    home. Patient also given follow-up appointment for removal of the
    skin sutures.
    Shirley CPC,CPC-H

  2. #2

    Default Tunneled peritoneal paracentesis

    The codes are 49421 & 75989.
    49421-Because the catheter is tunneled.
    Hope this Helps!!

  3. #3


    I concur

  4. #4


    Thank you!
    Shirley CPC,CPC-H

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