CPT 49326 Omental Tuck Reimbursement & Policy | OpenPayer

Summary & Overview

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare49326CPTlaparoscopyintraperitoneal catheteromental-tucksurgical-add-onambulatory-surgeryoperative-report

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.

Service type: Surgical add-on procedure, laparoscopic intra-abdominal intervention
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.

CPT 49327: Laparoscopic Placement of Fiducial Markers or Dosimeter

CPT-49325-LAPAROSCOPIC-INTRAPERITONEAL-CATHETER-OBSTRUCTION-REMOVAL

CPT 49325: Laparoscopic Removal of Intraperitoneal Catheter Obstruction

CPT-49322-LAPAROSCOPIC-ASPIRATION-INTRA-ABDOMINAL-FLUID-CYSTS

CPT 49322: Laparoscopic Aspiration of Intra-Abdominal Fluid/Cysts

CPT-49323-LAPAROSCOPIC-LYMPHOCELE-DRAINAGE

CPT 49323: Laparoscopic Drainage of Abdominal Lymphocele

CPT-49320-DIAGNOSTIC-LAPAROSCOPY-PERITONEUM-OMENTUM-INSPECTION

CPT 49320: Diagnostic Laparoscopy of Peritoneum and Omentum

CPT-49321-DIAGNOSTIC-LAPAROSCOPY-WITH-BIOPSY

CPT 49321: Diagnostic Laparoscopy With Biopsy

CPT-49324-LAPAROSCOPIC-PERITONEAL-CATHETER-PLACEMENT-ASCITES-DRAINAGE

CPT 49324: Laparoscopic Peritoneal Catheter Placement for Ascites Drainage

CPT-49329-LAPAROSCOPIC-ABDOMEN-PERITONEUM-OMENTAL-OTHERS

CPT 49329: Laparoscopic Procedure, Abdomen/Peritoneum/Omentum

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.

OpenPayer