# Open Revision of a PD Catheter



## ch81059 (Nov 27, 2013)

Hi,

I need some assistance with coding this procedure.  The physician called it a "revision" of a pd catheter for which there is no code when it is done open.  From the operative report he removed the external portion of the catheter along with some indurated tissue then replaced the external portion and created a new exit site. I am leaning towards 49999 but am not sure of what comparable code I should use for pricing and payment purposes.  Any assistance would be greatly appreciated. 

PREOPERATIVE DIAGNOSIS
Recurrent infection at peritoneal dialysis catheter exit site.

POSTOPERATIVE DIAGNOSIS
Recurrent infection at peritoneal dialysis catheter exit site.

PROCEDURE PERFORMED
Revision of peritoneal dialysis catheter.

HISTORY OF PRESENT ILLNESS
who is seen for a chronic
infection of his peritoneal dialysis catheter exit site, __________
antibiotics. On examination he has no active infection. However, the
surrounding area is indurated from recurrent superficial infections. The
catheter otherwise functions. He has no apparent __________ The patient
would like to go forth with the catheter revision rather than continue
antibiotics. Risks and benefits were discussed with the patient, he
agreed to proceed.

PROCEDURE IN DETAIL
The patient was brought to the operating room, placed in supine position
on the operating room table. After general endotracheal anesthesia was
induced, the abdomen was prepped and draped in the usual sterile
fashion. Cut down. Took a little piece of skin containing the catheter
exit site and the surrounding indurated tissue. This was dissected using
a #15 blade. This was dissected down to the fascia using electrocautery,
and dissected around abnormal-appearing tissue. The specimen was
removed, including the external portion of the peritoneal dialysis
catheter, which was cut from the intraperitoneal portion. The remaining
catheter was hooked back up to catheter extension piece. A 2nd small
incision was made about 10 cm above the initial exit site. We then used
a curved dilator to catheter, including the cuff was pulled up through
the skin to the new exit site, taking care to ensure that it was laying
flat and not kinked. Hemostasis was achieved using electrocautery. The
dermis was then reapproximated using a running 2-0 Vicryl suture, and
the skin was closed using interrupted 2-0 nylon sutures. The entire
thing was covered with a sterile dressing.

Any help is greatly appreciated!


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## Elizabeth83 (Dec 19, 2013)

*PC catheter revision*

I use the unlisted as well, and compare it to the Laparoscopic revision(49325). I haven't had any problems getting it paid.  I have wondered if billing a 49422-52 and 49421-52 would be appropriate as well.  It would be nice to get some feedback from others.


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