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Basics about Peritoneal-venous shunt CPT code 49425, 49426, 49427, 49428 & 49429

A peritoneal-venous shunt is a surgical connection made between the peritoneal space and the venous system. Peritoneovenous shunts are used in the treatment of recurrent ascites or recurrent pleural effusions. Generally speaking, the shunts allow passage of ascites or pleural effusions (by either passive or active means) back into the central venous system. The shunt is connected to a one-way valve to prevent backflow of blood into the peritoneal space. The end of the tube is placed in the venous system near the heart. The most recent development in peritoneovenous shunts, known as the Denver Shunt, is a modification of a shunt developed for the treatment of hydrocephalus. CPT code 49425, 49426, 49427, 49428 & 49429 are used for coding peritoneal-venous shunt procedures.

The physician places a peritoneal-venous shunt. The physician makes a small lateral upper abdominal incision, entered into the peritoneum and the peritoneal end of the catheter is inserted into the peritoneal cavity and sutured into place. A subcutaneous tunnel is created from the abdominal incision up to the neck and the catheter is pulled through the tunnel into the neck. A counter incision is made in the neck over the internal jugular vein and the venous end of the catheter is inserted into the jugular vein. The incisions are closed. CPT code 49425 is used for insertion of peritoneal venous shunt.

For revision physician may remove the shunt by incisions over the venous and peritoneal insertion sites with a subcutaneous tunnel is created from the abdominal incision up to the neck and the catheter is pulled through the tunnel into the neck. CPT code 49426 is used for peritoneal venous shunt revision.

For injection procedure, the physician injects contrast into a peritoneo-venous shunt. The physician injects contrast material through the skin into the reservoir of the peritoneo-venous shunt. Radiography is used to visualize the flow of contrast through the shunt into the peritoneal and venous ends for evaluation. CPT code 49427 is used for injection procedure for peritoneal venous shunt evaluation.

For Ligation, the physician makes an incision over the path of the shunt. The shunt tubing under the incision is isolated and ligated with sutures. The incision is closed. CPT code 49428 for ligation of peritoneal venous shunt.

For removal of peritoneal venous shunt, the physician makes an incision over the abdominal insertion site of the shunt. The shunt is dissected from surrounding scar tissue and removed from the abdominal cavity. CPT code 49429 is used for removal of peritoneal venous shunt.

Codes description of CPT code 49425, 49426, 49427, 49428 & 49429

49425 Insertion of peritoneal-venous shunt

49426 Revision of peritoneal-venous shunt

49427 Injection procedure (eg, contrast media) for evaluation of previously placed peritoneal-venous shunt

49428 Ligation of peritoneal-venous shunt

49429 Removal of peritoneal-venous shunt

75809 Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation

To assign CPT code 75809, the physician injects contrast material through the skin into the reservoir of a peritoneal-venous shunt or directly into shunt tubing or reservoir with a needle. Shunt tubing is a drain to eliminate excess cerebral spinal fluid in cases of hydrocephalus. The tubing of a peritoneal-venous shunt drains the accumulation of fluids in cases of ascites into a major vein. The physician places the needle and injects radiologic dye. Pictures are taken to visualize the flow of contrast and check for effective drainage. This code reports the radiological supervision and interpretation only. Use a separately reportable code for the shuntogram injection procedure.

78291 Peritoneal-venous shunt patency test (eg, for LeVeen, Denver shunt)

In CPT code 78291, diagnostic nuclear medicine imaging test is done for peritoneovenous shunt patency in patients with intractable ascites. The shunt is plastic tubing equipped with a pressure valve that is inserted to connect the peritoneal cavity to the internal jugular or subclavian vein and permit the return of ascites fluid and proteins to the venous system. Normal inspiration creates the necessary intra-abdominal versus intrathoracic pressure change that allows the pressure valve to open and drain the ascites fluid. The ascites fluid is radiolabeled and followed by imaging with a camera that detects the gamma radiation from the radiotracer introduced into the patient. If the fluid is circulating into the systemic system correctly through a patent shunt, the radiotracer will appear in the cells of the liver.

Do and don’t for Peritoneal-venous shunt

For shunt patency test, use CPT code 78291, Peritoneal-venous shunt patency test (eg, for LeVeen, Denver shunt)

Peritoneal-venous shunt is not a dialysis shunt or a ventriculoperitoneal shunt. Do not use code 36901, 61070, or 75809 for this procedure.

Use CPT code 75809 and 78291 as radiological supervision and interpretation along with injection procedure CPT code 49427.

CPT code 75809 should be used for contrast peritoneal-venous shuntogram

CPT code 78291 for nuclear medicine peritoneal-venous shuntogram. Diagnostic nuclear medicine imaging test is done to check the peritoneovenous shunt patency in patients with intractable ascites. In this exam, the ascites fluid are radiolabeled and followed by imaging with a camera that detects the gamma radiation from the radiotracer introduced into the patient.