# Peritoneal Drain Eval with Fluoro



## jtuominen (Oct 7, 2009)

Hi there-- How would you code the fluoroscopic evaluation of this peritoneal drainage catheter? I am not coming up with anything that feels right--maybe 49424?? or just 76000?? Otherwise All I can think of is the unlisted code 49999. So far I have 49080 for the drainage performed at the end of the procedure.

HISTORY: 59-year-old with pain after placement of right lower
quadrant abdominal/pelvic PleurX peritoneal drain.

TECHNIQUE: The patient was brought to the interventional radiology
department where there was a long discussion with myself, the patient,
and his wife. They describe an episode of severe pain near completion
of drainage several days prior. This pain terminated upon clamping the
tube. Additional mild low level discomfort within the pelvis and
within the tunneled tract in the right lower quadrant. There have been
instances of drainage without discomfort or complication.

Fluoroscopy was performed to demonstrate placement of the tube. A
total of 25 mL Hexabrix contrast was administered into the peritoneal
cavity without complication.

Fluoroscopy time: 0.7 minutes.
Sedation: None.
Local anesthesia: None.

COMPLICATIONS: None.

FINDINGS: Spot fluoroscopic image overlying the pelvis demonstrates
good position of the PleurX peritoneal drainage catheter. The position
is relatively unchanged compared to previous exam. Contrast collects
within the pelvic cavity.

IMPRESSION:
1. Good position of peritoneal drainage catheter with appropriate
function. However, the patient describes several episodes of severe
pain during drainage. Suspect this is due to suction being applied
upon the bladder, and possibly  surrounding loops of bowel. After
lengthy discussion, it was decided to attempt gravity drainage and
exclude any form of suction. While in the interventional department
today, 300 mL of clear yellow fluid was drained without complication
or discomfort.
2. Persistent pain in the right lower quadrant when the patient lies
in a right lateral decubitus position. Suspect this is due to the fact
the tube was placed 6 days prior. This should improve with continued
healing.


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## dpeoples (Oct 7, 2009)

jtuominen said:


> Hi there-- How would you code the fluoroscopic evaluation of this peritoneal drainage catheter? I am not coming up with anything that feels right--maybe 49424?? or just 76000?? Otherwise All I can think of is the unlisted code 49999. So far I have 49080 for the drainage performed at the end of the procedure.
> 
> HISTORY: 59-year-old with pain after placement of right lower
> quadrant abdominal/pelvic PleurX peritoneal drain.
> ...




Can you ask the physician how the contrast was "administered into the peritoneal cavity"? If through the drainage catheter (likely) then I would code 49424/76080, and I would also ask him/her to revise the document to support the code selection.

As for charging 49080 for the drainage, I think that was what was drained through the catheter, no additional procedures were performed. IMO

HTH


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