# tunneled peritoneal paracentesis



## Shirleybala (Jan 29, 2009)

Hi,
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
      necessary.

      Procedure:

      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.

      Impression:

      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.


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## Happycoding (Jan 29, 2009)

*Tunneled peritoneal paracentesis*

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


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## MLS2 (Jan 29, 2009)

I concur


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## Shirleybala (Jan 30, 2009)

Thank you!


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