Urology Coding Alert

"Question: What is the correct way to code for removal of a contaminated peritoneal dialysis catheter by mini-laparoscopy and an insertion of a new peritoneal dialysis catheter by mini-laparoscopy at a new site during the same surgery?

Texas Subscriber

Answer: The correct codes depend on whether the peritoneal dialysis catheter is permanent or temporary. If this is a permanent catheter (e.g., Tenckhoff), code 49421 (insertion of intraperitoneal cannula or catheter for drainage or dialysis; permanent) should be reported for the insertion of a new catheter, and code 49422 (removal of permanent intraperitoneal cannula or catheter) should be reported for the removal of the contaminated catheter. Modifier -59 (distinct procedural service) should be appended to 49422 to indicate the removal was from a different site.

If this is a temporary peritoneal dialysis catheter, only the insertion of the new catheter would be reported with code 49420 (insertion of intraperitoneal cannula or catheter for drainage or dialysis; temporary), and the removal would not be separately reported. The appropriate renal failure ICD-9 code should be linked to the insertion procedure code, and the ICD-9 code for infected peritoneal dialysis catheter (996.68) should be linked to the removal procedure code.
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