How To Use CPT Code 49435

CPT 49435 describes the insertion of a subcutaneous extension to an intraperitoneal cannula or catheter with a remote chest exit site. 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 49435?

CPT 49435 can be used to describe the procedure of inserting a subcutaneous extension to an intraperitoneal cannula or catheter with a remote chest exit site. This code is used when the provider adds an extension to the cannula or catheter, joining the two tubing components and securing the connecting joints. The provider then tunnels the extension subcutaneously from the abdominal insertion incision to an upper chest incision and extends the tube to the designated skin exit site.

2. Official Description

The official description of CPT code 49435 is: ‘Insertion of subcutaneous extension to intraperitoneal cannula or catheter with remote chest exit site (List separately in addition to code for primary procedure).’ This code should be used in conjunction with the primary procedure codes 49324 or 49421.

3. Procedure

1. After performing the primary procedure of cannula or catheter placement, the provider inserts a subcutaneous extension to the cannula or catheter.
2. The provider joins the two tubing components, such as by using a titanium connector, and secures the connecting joints with polypropylene ligatures.
3. A tunneling device is advanced from the abdominal insertion incision to an upper chest incision.
4. The provider pulls the extension tube through the subcutaneous tunnel.
5. The provider extends the tube from the upper chest incision to the designated skin exit site, ensuring appropriate positioning.
6. The provider completes the catheter placement, including testing for appropriate flow through the catheter and extension, and closes the abdominal incision in layers.

4. Qualifying circumstances

CPT 49435 is performed when the patient requires the insertion of a subcutaneous extension to an intraperitoneal cannula or catheter with a remote chest exit site. This procedure is typically performed in conjunction with the primary procedures of cannula or catheter placement (codes 49324 or 49421). The provider must ensure that the patient is appropriately prepped and anesthetized before performing the procedure.

5. When to use CPT code 49435

CPT code 49435 should be used when the provider performs the insertion of a subcutaneous extension to an intraperitoneal cannula or catheter with a remote chest exit site. This code should be reported in addition to the primary procedure code for cannula or catheter placement (49324 or 49421).

6. Documentation requirements

To support a claim for CPT 49435, the provider must document the following information:

• Confirmation of appropriate prepping and anesthesia of the patient
• Description of the primary procedure of cannula or catheter placement
• Details of the insertion of the subcutaneous extension, including joining the tubing components, securing the connecting joints, tunneling, and extending the tube to the designated skin exit site
• Testing for appropriate flow through the catheter and extension
• Closure of the abdominal incision in layers

7. Billing guidelines

When billing for CPT 49435, ensure that the procedure is performed in conjunction with the primary procedure codes 49324 or 49421. Payers may not reimburse for CPT 49435 if it is reported without an appropriate primary code. It is important to follow the specific guidelines provided by the payer regarding the reporting of this code.

8. Historical information

CPT 49435 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates to the code since its addition.

9. Examples

1. A provider inserts a subcutaneous extension to an intraperitoneal catheter with a remote chest exit site for a patient undergoing peritoneal-venous shunt placement.
2. During a procedure for the insertion of an intraperitoneal cannula, a provider adds a subcutaneous extension with a remote chest exit site to facilitate fluid drainage.
3. After placing an intraperitoneal catheter, a provider inserts a subcutaneous extension to the catheter with a remote chest exit site for long-term access.
4. For a patient with peritoneal dialysis, a provider performs the insertion of a subcutaneous extension to the intraperitoneal catheter with a remote chest exit site.
5. During a procedure for the placement of an intraperitoneal cannula, a provider adds a subcutaneous extension to the cannula with a remote chest exit site to allow for continuous fluid drainage.
6. A provider inserts a subcutaneous extension to an intraperitoneal catheter with a remote chest exit site for a patient requiring long-term intraperitoneal medication administration.
7. After placing an intraperitoneal cannula, a provider adds a subcutaneous extension with a remote chest exit site to facilitate the infusion of chemotherapy drugs.
8. For a patient with ascites, a provider performs the insertion of a subcutaneous extension to the intraperitoneal catheter with a remote chest exit site for regular drainage.
9. During a procedure for the placement of an intraperitoneal cannula, a provider adds a subcutaneous extension to the cannula with a remote chest exit site to allow for intermittent fluid drainage.
10. A provider inserts a subcutaneous extension to an intraperitoneal catheter with a remote chest exit site for a patient requiring long-term intraperitoneal nutrition.