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Thread: Paracentesis

  1. #1

    Default Paracentesis

    AAPC: Back to School
    Can we code the following procedure with 49021 & 75989-26 alone or do we need to add 49080 & 76942-26 also.Kindly confirm.

    Ultrasound Guided Paracentesis:
    Clinical history: 59-year-old male with lymphoma and intractable
    ascites requiring weekly therapeutic paracentesis. Patient
    referred for placement of a tunneled Tenckhoff peritoneal catheter
    and therapeutic paracentesis.


    Initial ultrasound images demonstrated a large pocket of ascitic
    fluid with no evidence of superficial loops of bowel or
    carcinomatosis in the left lower quadrant just inferior into the
    left of the umbilicus. The skin was then marked at the expected
    site are peritoneal entry.

    The left lower quadrant was then prepped and draped in the usual
    sterile fashion. Ultrasound was then used to reconfirm the site
    of expected peritoneal entry. In addition, an approximate 15 cm
    tract was marked and anesthetized with what was a lidocaine in the
    left lower quadrant.

    Under fluoroscopic guidance, an 18 gauge x 10 cm trochar needle
    was then advanced into the subcutaneous tissues and along the
    anesthetized tract. Careful attention was made not to advance the
    needle into the dermis or penetrate the peritoneum.

    A 5 cm curve was then placed on the distal tip of a 22 cm x 15 cm
    diamond tipped needle. The needle was then coaxially loaded
    through the 18 gauge trochar needle. With external pressure being
    placed on the expected location of peritoneal entry, the 22 gauge
    needle was advanced and used to gain access into the peritoneum.
    The inner style that of the needle was removed and return of
    cloudy yellow peritoneal fluid was identified. Fluoroscopic
    images confirmed needle entry at the planned site of peritoneal

    At only a wire was advanced through the 22 gauge needle and coiled
    within the peritoneum. The needle was removed and exchanged for a
    six French transition dilator which was advanced into the
    peritoneum. The inner dilator was then removed and an Amplatz
    wire was coaxially loaded through the transition dilator alongside
    the 018 wire. The transition dilator was then removed. The inner
    dilator was then readvanced over the 018 wire after which, the
    wire was removed.

    The transition dilator was then slowly drawn back while injecting
    0 percent lidocaine with epinephrine to deliver further local
    anesthesia to the tunnel tract.

    Serial dilatation of the tract over the Amplatz wire was
    performed. An 18 French peel-away sheath was then advanced over
    the wire and positioned with its distal tip within the peritoneum.
    The 15 French x 42 cm Tenckhoff catheter was coaxially loaded onto
    a six French Berenstein catheter. The inner dilator of the peel
    away sheath was removed and a rush of peritoneal fluid was
    identified. The Berenstein catheter and Tenckhoff catheter were
    then advanced over the wire and through the peel away sheath. The
    total sheath was then removed. The catheter was positioned within
    the peroneal with its cuff approximately 2 cm within the tunnel
    tract. The Berenstein catheter and wire were then removed and a
    rush of peritoneal fluid from the Tenckhoff catheter was
    identified. No leakage around the catheter tract was identified.

    The catheter was then attached to gravity drainage and secured to
    the skin with 2 0 prolene suture. Bacitracin ointment and a
    biopatch was placed over the catheter at its skin entry site and a
    sterile dressing was applied.

    The patient was brought to the recovery room where 10 liters of
    cloudy yellow fluid was aspirated. During paracentesis the
    patient received 225 ml of 25% albumin.

    The patient tolerated the procedure well and was discharged home
    in stable condition. There are no immediate complications.

    Successful placement of a 15 French x 42 cm tunneled Tenckhoff
    peritoneal drainage catheter in the left lower quadrant as
    described above.

    Successful aspiration of approximately 10 liters of cloudy yellow
    peritoneal fluid as described above.
    Prabha CPC

  2. #2


    I would code 32550, 75989 and 49080, 76942 since the para is done separately in the recovery room

    Leslie, CPC, CPC-H, RCC, CIRCC

  3. #3


    Your code for the peritoneal drainage catheter would be 49420 or 49421. As for the drainage in recovery, I think the purpose of the catheter is to drain the fluid so it would be normal to see drainage in the recovery. Was your physician in the recovery room continuing to do a separate procedure?

    Certainly I could have missed something in the report but that's what I see.

    Diane Huston, CPC,RCC

  4. #4


    I agree with the 49420/49421. I'm leaning more towards the 49421 due to the tunnel that was mentioned. That typically means "long term".

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