How To Use CPT Code 49425

CPT 49425 describes the insertion of a peritoneal-venous shunt, a procedure performed by a healthcare provider to create an outlet for peritoneal fluid to drain into a vein and away from the heart. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 49425?

CPT 49425 is a code used to describe the surgical procedure in which a healthcare provider creates a pathway for peritoneal fluid to drain into a vein, diverting it away from the heart. This is achieved by inserting a catheter into the abdominal cavity and connecting it to another catheter inserted into the jugular vein in the neck.

2. Official Description

The official description of CPT code 49425 is the following: ‘Insertion of peritoneal-venous shunt.’

3. Procedure

1. The healthcare provider begins by making a small incision in the upper abdomen and dissecting through the layers of tissue to access the peritoneal cavity.
2. A catheter, such as a one-way valve catheter, is inserted into the peritoneal cavity and sutured in place.
3. Using a tunneler, the provider creates a passage from the peritoneum to the drainage site, typically in the neck.
4. Another catheter is inserted into the jugular vein through a small incision and sutured in place.
5. A tube is passed through the subcutaneous tunnel and connected to both catheters, allowing for the diversion of peritoneal fluid into the venous system.
6. The healthcare provider ensures proper flow through the shunt and achieves hemostasis before closing the incisions.

4. Qualifying circumstances

CPT 49425 is performed on patients who require the diversion of peritoneal fluid into the venous system. This procedure is typically indicated for individuals with an accumulation of peritoneal fluid that needs to be drained away from the heart. The healthcare provider must assess the patient’s condition and determine the appropriateness of the procedure.

5. When to use CPT code 49425

CPT code 49425 should be used when a healthcare provider performs the insertion of a peritoneal-venous shunt. It is important to ensure that the procedure meets the specific criteria outlined in the code description. If the procedure does not involve the insertion of a peritoneal-venous shunt, a different code should be used.

6. Documentation requirements

To support a claim for CPT 49425, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the peritoneal-venous shunt
• Details of the procedure, including the specific catheters used and their placement
• Date of the procedure
• Any complications or adverse events that occurred during or after the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 49425, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The healthcare provider should also follow any additional billing guidelines provided by the payer. It is important to review the payer’s policies and guidelines to ensure accurate and appropriate billing.

8. Historical information

CPT 49425 was added to the Current Procedural Terminology system on January 1, 1990. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A healthcare provider performs the insertion of a peritoneal-venous shunt to divert peritoneal fluid in a patient with end-stage renal disease.
2. A patient with liver cirrhosis undergoes the insertion of a peritoneal-venous shunt to manage ascites.
3. A healthcare provider performs the insertion of a peritoneal-venous shunt in a patient with peritoneal cancer to alleviate symptoms caused by fluid accumulation.
4. A patient with heart failure undergoes the insertion of a peritoneal-venous shunt to manage pleural effusion.
5. A healthcare provider performs the insertion of a peritoneal-venous shunt in a patient with peritonitis to drain infected fluid.
6. A patient with ovarian cancer undergoes the insertion of a peritoneal-venous shunt to manage malignant ascites.
7. A healthcare provider performs the insertion of a peritoneal-venous shunt in a patient with mesothelioma to alleviate symptoms caused by fluid accumulation.
8. A patient with pancreatic cancer undergoes the insertion of a peritoneal-venous shunt to manage ascites.
9. A healthcare provider performs the insertion of a peritoneal-venous shunt in a patient with lymphoma to alleviate symptoms caused by fluid accumulation.
10. A patient with peritoneal tuberculosis undergoes the insertion of a peritoneal-venous shunt to manage ascites.