2025 CPT code 49435
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Insertion of a subcutaneous extension to an intraperitoneal cannula or catheter, with a remote chest exit site. This code is an add-on and should be reported in addition to the primary procedure.
Medical necessity must be established for the primary procedure requiring the cannula/catheter placement.The use of 49435 is justified when a chest exit site provides a clinical advantage for long-term management, ease of access, or patient comfort.
The physician is responsible for prepping and anesthetizing the patient, performing the primary cannula/catheter placement, connecting and securing the extension, tunneling the extension subcutaneously to the chest exit site, ensuring proper placement and function of the entire system, and closing the surgical incisions.
In simple words: During the same procedure where a tube (cannula or catheter) is placed into the abdomen, a surgeon adds an extension to this tube and tunnels it under the skin to an exit point in the upper chest.This allows for easier access and management of the catheter outside the body.
This add-on procedure involves extending an existing intraperitoneal cannula or catheter by tunneling a subcutaneous extension to a remote chest exit site. It is performed during the same operative session as the initial cannula or catheter placement.The extension is connected to the cannula/catheter and secured. A tunneling device is used to create a pathway from the abdominal incision to an upper chest incision, through which the extension is passed. The extension is then positioned appropriately at the chest exit site, and its proper function is confirmed before closing the incisions.
Example 1: A patient undergoing laparoscopic surgery requires a long-term intraperitoneal catheter for drainage.The surgeon places the catheter laparoscopically (49324) and then uses this code (49435) to create a subcutaneous tunnel and a chest exit site for easier access., A patient with ascites requires placement of a peritoneal catheter for drainage.The surgeon performs a percutaneous insertion (49421) and then adds a subcutaneous extension to a chest exit site (49435) during the same procedure., A patient with a previous abdominal catheter insertion requires an extension to allow for more comfortable management of the drainage system at home. During a subsequent procedure, code 49435 is used to tunnel the extension and create a new chest exit point.
Documentation should include the primary procedure performed (49324 or 49421), the type of cannula/catheter used, the method of extension connection, the path of the subcutaneous tunnel, the location of the chest exit site, and confirmation of proper catheter function.
- Specialties:General Surgery, Surgical Oncology, Gastroenterology, Interventional Radiology.
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center