2025 CPT code 49418
Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Percutaneous insertion of a tunneled intraperitoneal catheter for dialysis, chemotherapy, or ascites management, including imaging guidance, contrast injection, and radiological supervision.
Modifiers may be applicable to indicate specific circumstances, such as increased procedural services (22), multiple procedures (51), reduced services (52), or assistant surgeon (80).
Medical necessity is established by the underlying condition requiring access to the peritoneal cavity, such as end-stage renal disease, abdominal malignancy requiring intraperitoneal chemotherapy, or intractable ascites.
The physician preps and anesthetizes the patient, then places a needle or makes a small incision in the abdominal wall under imaging guidance. Contrast material may be injected for better visualization. The catheter is placed into the peritoneum, and a tunneler creates a subcutaneous tunnel for the catheter tubing. The tubing is threaded through the tunnel to another abdominal exit site. Pressure is applied to stop bleeding, and an appropriate bag or appliance is attached to the catheter tubing.
In simple words: This procedure involves inserting a soft tube (catheter) into the abdominal cavity through a small incision in the skin.The catheter is then tunneled under the skin to another exit point on the abdomen. Imaging is used to guide the placement, and sometimes dye is injected to make it easier to see. This catheter can be used for dialysis, delivering chemotherapy directly to the abdomen, or draining excess fluid.
Insertion of tunneled intraperitoneal catheter (e.g., dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous.
Example 1: A patient with end-stage renal disease requires a peritoneal dialysis catheter for at-home dialysis., A patient with ovarian cancer requires an intraperitoneal catheter for chemotherapy administration directly into the abdominal cavity., A patient with cirrhosis and refractory ascites requires a catheter for drainage of excess abdominal fluid.
Documentation should include the medical necessity for the procedure (e.g., dialysis, chemotherapy, ascites management), type of catheter inserted, method of insertion (percutaneous), use of imaging guidance and contrast, and any complications encountered.
- Specialties:Nephrology, Oncology, Interventional Radiology, Gastroenterology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center