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peritoneal dialysis catheter

  1. Default peritoneal dialysis catheter
    Medical Coding Books
    Procedure: Ultrasound and fluoroscopically guided insertion of a
    tunneled peritoneal paracentesis catheter

    Procedure:
    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
    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 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
    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    was withdrawn through the entire tract.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. 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.
    Prabha CPC

  2. Default
    Yes we can code

  3. #3
    Default
    I would do the 75989/49421 also

  4. Default
    I don't agree, I think this should be 49418. This code includes all imaging guidance, cath plcment etc.

  5. #5
    Location
    Birmingham, Alabama
    Posts
    890
    Default
    Quote Originally Posted by Heidi Reitmeier View Post
    I don't agree, I think this should be 49418. This code includes all imaging guidance, cath plcment etc.
    You are correct, but 49418 was introduced (new code) in 2011. This question was from 2009.

    Danny L. Peoples
    CIRCC,CPC

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