How To Use CPT Code 49421

CPT 49421 describes the insertion of a tunneled intraperitoneal catheter for dialysis in patients with kidney disease. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 49421?

CPT 49421 is used to describe the surgical procedure of inserting a catheter within the abdominal cavity for patients with kidney disease who require dialysis. This code specifically refers to the insertion of a tunneled intraperitoneal catheter, which is used to drain recurrent accumulation of fluid in the abdomen.

2. Official Description

The official description of CPT code 49421 is the “Insertion of tunneled intraperitoneal catheter for dialysis, open.” This code is used when the provider surgically places a catheter within the peritoneum, the membrane lining the abdominal cavity, to facilitate dialysis in patients with kidney dysfunction. It is important to note that for laparoscopic insertion of a tunneled intraperitoneal catheter, a different code, 49324, should be used.

3. Procedure

1. When performing the procedure, the provider begins by making an incision in the midline of the abdomen.
2. They carefully examine the organs and structures to identify a suitable space for catheter placement.
3. Using a tunneler, the provider creates a tunnel through the subcutaneous tissues.
4. They then insert the catheter into the appropriate area of the peritoneum.
5. The tubing connected to the catheter is threaded through the tunnel and emerges through the skin at another site on the abdomen.
6. After achieving hemostasis, the provider removes any instruments and closes the wound in layers.
7. In some cases, the provider may also extend an intraperitoneal catheter at a remote chest site during the same procedure.

4. Qualifying circumstances

CPT 49421 is performed on patients with kidney disease who require dialysis. The procedure is indicated when there is a need to drain recurrent accumulation of fluid in the abdomen. It is important to note that for laparoscopic insertion of a tunneled intraperitoneal catheter, a different code, 49324, should be used.

5. When to use CPT code 49421

CPT code 49421 should be used when a provider performs the open insertion of a tunneled intraperitoneal catheter for dialysis in patients with kidney disease. It is important to use this code specifically for open procedures and not for laparoscopic insertion, which has its own distinct code (49324).

6. Documentation requirements

To support a claim for CPT 49421, the provider must document the following information:

• Patient’s diagnosis of kidney disease and the need for dialysis
• Details of the procedure, including the incision site and technique used
• Specific catheter used and its placement within the peritoneum
• Any additional procedures performed, such as extending the catheter at a remote chest site
• Date of the procedure and the provider’s signature

7. Billing guidelines

When billing for CPT 49421, ensure that the procedure performed is the open insertion of a tunneled intraperitoneal catheter for dialysis. It is important to use the appropriate code for laparoscopic insertion (49324) or other related procedures. Follow any additional guidelines provided by the payer or coding guidelines to ensure accurate billing and reimbursement.

8. Historical information

CPT 49421 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2011, when it was updated to specify the insertion of a permanent intraperitoneal catheter for drainage or dialysis.

9. Examples

1. A surgeon performing the open insertion of a tunneled intraperitoneal catheter for dialysis in a patient with end-stage renal disease.
2. An interventional radiologist placing a tunneled intraperitoneal catheter for dialysis in a patient with chronic kidney disease.
3. A nephrologist performing the open insertion of a tunneled intraperitoneal catheter for dialysis in a patient with polycystic kidney disease.
4. A urologist inserting a tunneled intraperitoneal catheter for dialysis in a patient with renal failure.
5. A general surgeon performing the open insertion of a tunneled intraperitoneal catheter for dialysis in a patient with diabetic nephropathy.
6. An interventional radiologist placing a tunneled intraperitoneal catheter for dialysis in a patient with glomerulonephritis.
7. A nephrologist performing the open insertion of a tunneled intraperitoneal catheter for dialysis in a patient with nephrotic syndrome.
8. A urologist inserting a tunneled intraperitoneal catheter for dialysis in a patient with renal artery stenosis.
9. A general surgeon performing the open insertion of a tunneled intraperitoneal catheter for dialysis in a patient with renal cell carcinoma.
10. An interventional radiologist placing a tunneled intraperitoneal catheter for dialysis in a patient with acute kidney injury.