CPT 49326: Laparoscopic Omental Tuck to Relieve Catheter Occlusion
CPT code 49326 describes an add-on laparoscopic maneuver in which an omental loop is tacked away to relieve occlusion of an intraperitoneal catheter. As an adjunct performed during another planned laparoscopic abdominal exploration, this code captures a focused intra-abdominal correction intended to restore catheter function without a separate open procedure. Nationally, accurate reporting of such add-on codes matters for clinical documentation, surgical coding integrity, and facility/service line billing consistency.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how CPT code 49326 is typically used in operative reports, where it appears on the surgical service line, and how it relates to laparoscopic abdominal care pathways. Readers will find a concise clinical context for the procedure, guidance on common billing scenarios (including use as an add-on code during the same operative session), and benchmarks and policy updates relevant to payers and facilities. When available, the report highlights typical sites of service, documentation elements that support use of the code, and considerations for claims submission and adjudication. Data not available in the input will be noted where applicable.
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Billing Code Overview
CPT code 49326 is an add-on laparoscopic procedure performed after diagnostic or therapeutic laparoscopic exploration of the abdominal cavity. In this procedure the provider tucks away an omental loop that may be occluding an intraperitoneal catheter to restore or maintain catheter patency.
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Service type: Surgical add-on procedure, laparoscopic intra-abdominal intervention
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Typical site of service: Hospital operating room or ambulatory surgical center during a laparoscopic abdominal procedure
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult receiving a peritoneal dialysis catheter who presents for a planned laparoscopic procedure for another intra-abdominal indication (for example, diagnostic laparoscopy or elective hernia repair). During the laparoscopic exploration the surgeon identifies an omental loop intermittently occluding or wrapping the intraperitoneal catheter tip, causing poor dialysate flow or intermittent obstruction. The surgeon performs an add-on maneuver to tuck or reposition the omentum away from the catheter lumen and secure the catheter tip within the peritoneal cavity. The workflow includes preoperative evaluation for anesthesia, laparoscopic entry using standard ports, visualization of the catheter and omentum, gentle reduction or tacking of the omentum (without formal omentectomy), confirmation of catheter patency with instillation and drainage of fluid, and closure of laparoscopic port sites. Typical site of service is an operating room or ambulatory surgery center during a laparoscopic abdominal procedure; this is reported as an add-on code performed subsequent to the primary laparoscopic exploration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or intensity is substantially greater than typical for the primary laparoscopic procedure and documentation supports unusual effort related to the omental tucking. |
23 | Unusual anesthesia | Use when general anesthesia cannot be used and medically necessary unusual anesthesia is provided during the procedure. |
26 | Professional component | Use when billing split between technical and professional components, if applicable for facility/physician billing splits. |
50 | Bilateral procedure | Use if the omental tucking is performed on bilateral pathology and payer requires bilateral reporting (rare for this add-on). |
52 | Reduced services | Use when the add-on maneuver was attempted but only partially completed, with clear documentation of limitation. |
53 | Discontinued procedure | Use if the add-on was planned but the procedure was terminated for patient safety prior to completion. |
62 | Two surgeons | Use when two surgeons work together for distinct surgical complexities requiring reporting of an assisting surgeon. |
66 | Surgical team | Use when a surgical team approach is required and meets payer rules for team reporting. |
78 | Return to operating room for a related procedure during the global period | Use if patient returns to the OR for a related laparoscopic intervention for the catheter/omental problem during the global period. |
80 | Assistant surgeon | Use when an assistant surgeon provides direct operative assistance and payer requires modifier reporting. |
81 | Minimum assistant surgeon | Use when a minimum assistant surgeon is present per payer rules. |
82 | Assistant surgeon (when qualified resident unavailable) | Use when a qualified resident is not available and an assistant surgeon is used. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207L00000X | General Surgery | General surgeons commonly perform laparoscopic exploration and manipulation of intraperitoneal catheters. |
| 207LP2900X | Minimally Invasive Surgery | Surgeons with minimally invasive specialty focus frequently perform laparoscopic catheter salvage maneuvers. |
| 208800000X | Vascular Surgery | Vascular surgeons involved in dialysis access management may participate in catheter-related procedures. |
| 208000000X | Colon & Rectal Surgery | Colorectal surgeons may perform laparoscopic abdominal procedures encountering intraperitoneal catheters. |
| 3336C0002X | Nephrology (Interventional) | Interventional nephrologists may be involved in perioperative planning for peritoneal dialysis catheters but typically do not perform laparoscopic tucking. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
T85.698A | Other mechanical complication of other specified internal prosthetic devices, implants and grafts, initial encounter | Relevant for mechanical obstruction of a peritoneal dialysis catheter by omentum causing malfunction. |
T85.79XA | Other complication of other internal prosthetic devices, implants and grafts, initial encounter | Used for nonspecified complications of intraperitoneal catheters encountered during laparoscopy. |
T82.898A | Other mechanical complication of other cardiac and vascular prosthetic devices, implants and grafts, initial encounter | Included when coding systems require broader device complication codes; may be used if device code mapping varies. |
N18.6 | End stage renal disease | Common underlying condition for patients with peritoneal dialysis catheters who may experience catheter obstruction. |
K59.9 | Functional intestinal disorder, unspecified | Sometimes used when bowel-related motility issues contribute to intermittent catheter occlusion by omentum (supporting rather than primary code). |
K65.9 | Peritonitis, unspecified | Relevant when inflammation or infection around catheter/omentum is present and identified during laparoscopy. |
Z45.2 | Encounter for adjustment and management of vascular device, unspecified | Used for encounters related to management of implanted catheters; applicable in some payer coding conventions. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
49320 | Laparoscopy, abdomen, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) | Often the primary laparoscopic exploration code during which the add-on 49326 is reported when omental tucking is performed subsequent to diagnostic laparoscopy. |
49422 | Replacement, intraperitoneal catheter, with subcutaneous cuff, surgical; with diagnostic laparoscopy (if performed) | Performed when catheter requires formal replacement rather than simple omental repositioning; may be performed in the same operative session if tucking is unsuccessful. |
49421 | Revision, exterior portion of intraperitoneal catheter, with subcutaneous tunneling, when performed | Used when superficial catheter revision is required in addition to or instead of intra-abdominal omental tucking. |
43845 | Laparoscopy, surgical; cholecystectomy (for example) — representative intra-abdominal procedure | Representative of other laparoscopic abdominal surgeries during which 49326 may be performed as an add-on when a peritoneal dialysis catheter is encountered. |
47562 | Laparoscopy, surgical, cholecystectomy with cholangiography | Example of a laparoscopic operative case where incidental catheter issues could be addressed with the add-on code; demonstrates concurrent operative environment. |
49406 | Insertion of tunneled intraperitoneal catheter for dialysis | Performed when placing a new peritoneal dialysis catheter; subsequent omental tucking may be needed if future obstruction occurs. |