# peritoneal dialysis catheter



## prabha

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      was withdrawn through the entire tract.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.


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## Shirleybala

Yes we can code


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## MLS2

I would do the 75989/49421 also


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## Heidi Reitmeier

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


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## dpeoples

Heidi Reitmeier said:


> 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.


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