# Paracentesis



## prabha

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.        

       Procedure:                    

       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
       entry.

       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.

       Impression:
       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.


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## Leslie Jones

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

Leslie, CPC, CPC-H, RCC, CIRCC


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## dhuston

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


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## MLS2

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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