# Help with peritoneal port and chest port



## chembree (Sep 30, 2011)

INDICATION: Malfunction of peritoneal port, pain with chemotherapy
   administration and CT findings of possible occlusion of peritoneal port
   distal aspect.

   After written informed consent was obtained and under sterile
   conditions, after administration of local anesthetic, the peritoneal
   port was accessed under fluoroscopic guidance with a 19-gauge Huber
   needle. Contrast was administered. With hand-injection of contrast,
   there was filling of the peritoneal space outlining loops of bowel
   within the left lower quadrant, tracking laterally and superiorly with
   time, and a volume of 40 mL being administered of diluted contrast and
   saline. There was minimal backtracking of contrast along the sidewall of
   the port seen to occur with moderate forceful injection. With slow
   injection, there was dispersion of the contrast throughout the
   peritoneal cavity which over time out to 10 minutes dispersed normally
   without  persistence of contrast at the catheter tip. The entirety of
   the catheter lumen is patent.

   Catheter was then loaded with 100 units/mL of heparin.

   After discussion with infusion nurse, I was asked also to confirm
   patency and function of chest port. Fluoroscopic evaluation revealed no
   evidence of kinking in the tip of the port overlying the SVC just
   proximal to the right atrium in good location. The left chest port was
   accessed under sterile conditions after administration of local
   anesthetic with a 19-gauge Huber needle. Contrast was administered
   demonstrating patency of the port lumen and rapid flow into the SVC
   without hindrance. There is no evidence of fibrin sheath. Blood could be
   aspirated from the port repeatedly. The port was then loaded with 100
   units/mL heparin and Huber needle withdrawn. The patient tolerated the
   procedure well.

   The patient did receive IV Versed and fentanyl given intravenously for a
   total of 30 minutes.

   IMPRESSION: 

   Peritoneal port is functional with normal dispersion of injected
   material throughout the peritoneum, demonstrated without evidence of
   seroma at the tip of the catheter nor blockage of the catheter.
   Administration of chemotherapy via gravity should work well.

   Left chest port in place and functional without evidence of
   complication. Blood could be aspirated. Catheter tip is in good
   location.



I have looked at codes 49427 and 78291 but this does not say anything about being venous related and I have also looked at 49424 and 76080 but this was not done to evalute abscess or cyct.... can anyone offer any help?


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## Rajebpt (Oct 2, 2011)

Hi,
 peritoneal catheter injection-49424,76080
 port injection-36598


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## chembree (Oct 3, 2011)

Rajebpt said:


> Hi,
> peritoneal catheter injection-49424,76080
> port injection-36598



Do you think 49424 and 76080 is still appropriate even though it was not done to evalute an abscess or cyct?

I can't find much guidance for these codes other than what is printed in the CPT book.


Thanks
Christy, CPC


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## Rajebpt (Oct 6, 2011)

Hi,
We dont have any other codes for peritoneal injection.I used to code the same


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