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The CPT® Code 49419 refers to the procedure involving the insertion of a tunneled intraperitoneal catheter that includes a subcutaneous port, which is also known as a totally implantable port. This type of catheter is designed to remain indwelling, meaning it is placed inside the body and does not have any external access ports, allowing for a more discreet and comfortable option for patients. The primary applications of this catheter include the infusion of chemotherapeutic agents directly into the abdominal cavity and facilitating intraperitoneal dialysis, which is a treatment for kidney failure. The procedure involves making an incision in the upper abdomen, through which the peritoneum is accessed. During the insertion, any adhesions present in the abdominal cavity are carefully lysed, and the bowel is dissected as necessary to create a clear space within the peritoneum, ensuring that the catheter can be placed without obstruction. A subcutaneous pocket is then created for the port, which is sutured to the fascia and filled with heparinized saline to maintain patency. The catheter is tunneled through the subcutaneous tissue to the peritoneal cavity, where it is advanced after puncturing the peritoneum. Finally, the functionality of the port and catheter is verified to ensure that fluids can flow freely into the abdominal cavity, after which the incisions are closed securely.
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The insertion of a tunneled intraperitoneal catheter with a subcutaneous port is indicated for specific medical conditions and treatment protocols. The following are the primary indications for this procedure:
The procedure for the insertion of a tunneled intraperitoneal catheter with a subcutaneous port involves several critical steps, each designed to ensure proper placement and functionality of the catheter.
After the insertion of the tunneled intraperitoneal catheter with a subcutaneous port, patients may require specific post-procedure care to ensure proper healing and functionality of the catheter. Monitoring for signs of infection at the incision sites is essential, as well as ensuring that the catheter remains patent. Patients may also need to be educated on how to care for the port and catheter, including maintaining cleanliness and recognizing any potential complications. Follow-up appointments will be necessary to assess the catheter's function and to manage any treatments that may be administered through the catheter.
| Short Descr | INSERT TUN IP CATH W/PORT | Medium Descr | INSERTION TUNNEL INTRAPERITONEAL CATH SUBQ PORT | Long Descr | Insertion of tunneled intraperitoneal catheter, with subcutaneous port (ie, totally implantable) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 99 - Other OR gastrointestinal therapeutic procedures |
| 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
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Action
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Notes
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| 2011-07-01 | Changed | Added guidelines regarding deleted code 49420. |
| 2011-01-01 | Changed | Long description revised. Medium description changed. Short description changed. |
| 2003-01-01 | Added | First appearance in code book in 2003. |
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