© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 49425 refers to the procedure of inserting a peritoneal-venous shunt, which is a medical intervention designed to manage ascites, a condition characterized by the accumulation of fluid within the peritoneal cavity. This procedure involves the placement of a shunt that facilitates the drainage of excess fluid from the peritoneal cavity into the venous system, thereby alleviating the symptoms associated with ascites. The insertion typically occurs through a small incision made over the subclavian vein, although the internal jugular vein may also be utilized as an access point. The procedure is performed under sterile conditions, and the physician carefully exposes the vein to insert an introducer sheath, which serves as a conduit for the venous catheter. The catheter is then advanced into the superior vena cava, and a tunnel is created in the subcutaneous tissue to connect the catheter to the peritoneal cavity. This connection is established by advancing the shunt tubing through the tunnel and into the peritoneal space. A pressure-sensitive one-way valve is integrated into the system to ensure that fluid can flow from the peritoneal cavity into the venous system while preventing any backflow of blood, thus maintaining proper hemodynamics. This procedure is critical for patients suffering from significant fluid retention due to various underlying conditions, and it plays a vital role in improving their quality of life.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 49425 is indicated for the treatment of ascites, which is the pathological accumulation of fluid in the peritoneal cavity. This condition can arise from various underlying medical issues, including liver cirrhosis, heart failure, malignancies, and infections. The insertion of a peritoneal-venous shunt is performed to alleviate the symptoms associated with this fluid buildup, such as abdominal distension, discomfort, and difficulty breathing due to pressure on the diaphragm.
The procedure for the insertion of a peritoneal-venous shunt involves several critical steps to ensure proper placement and functionality of the shunt.
After the insertion of the peritoneal-venous shunt, patients are typically monitored for any immediate complications, such as bleeding or infection at the incision site. Post-procedure care may include pain management and instructions on how to care for the incision. Patients may also be advised on signs of potential complications, such as changes in fluid output or signs of infection. Follow-up appointments are essential to assess the functionality of the shunt and to make any necessary adjustments or revisions, particularly if the shunt is not functioning as intended.
| Short Descr | INSERT ABDOMEN-VENOUS DRAIN | Medium Descr | INSERTION PERITONEAL-VENOUS SHUNT | Long Descr | Insertion of peritoneal-venous shunt | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 99 - Other OR gastrointestinal therapeutic procedures |
| 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician |
|
Date
|
Action
|
Notes
|
|---|---|---|
| Pre-1990 | Added | Code added. |
Get instant expert-level medical coding assistance.