Summary & Overview
CPT 49425: Peritoneovenous Shunt Placement
CPT code 49425 identifies placement of a peritoneovenous shunt: a surgical procedure that connects the peritoneal cavity to the central venous system to divert ascitic fluid. Nationally, this code represents an infrequent but clinically significant intervention used for patients with refractory ascites when medical therapies are insufficient. It is relevant to hospitals, surgical specialties, and payers due to the procedure’s complexity, inpatient resource use, and potential complications.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent of the code, typical settings where the service is performed, and what to expect in billing and coverage discussions. The publication covers common modifiers and documentation considerations, national utilization and reimbursement benchmarks when available, and clinical context regarding indications and procedural implications. This summary is intended for billing professionals, clinicians involved in procedural care of ascites, and payer policy staff seeking a clear national perspective on CPT code 49425. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 49425 describes a surgical procedure that creates a controlled outlet for excess peritoneal fluid to drain into the venous circulation. In this operation, the surgeon inserts a catheter into the abdominal (peritoneal) cavity and connects it to a catheter placed in the internal jugular vein, establishing a pathway for ascitic fluid to be diverted away from the heart and into the venous system.
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Service type: Surgical shunt placement for management of refractory ascites
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Typical site of service: Hospital operating room or interventional suite where surgical venous and abdominal access can be performed under sterile conditions and imaging guidance when indicated
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with refractory ascites from cirrhosis (for example, decompensated alcoholic or viral hepatitis‑related cirrhosis) who has failed medical management including sodium restriction and diuretics and requires frequent large‑volume paracentesis. The patient presents with symptomatic tense ascites causing dyspnea, abdominal pain, poor appetite, or frequent hospital visits for therapeutic paracentesis. After multidisciplinary evaluation by hepatology and interventional radiology or vascular surgery, the decision is made to place a transjugular intrahepatic portosystemic shunt (TIPS) with a peritoneovenous shunt-like variant or to create a peritoneovenous drainage conduit by surgically connecting a peritoneal catheter to a central venous catheter via the jugular vein as described by CPT 49425.
The clinical workflow includes preoperative evaluation (laboratory tests, coagulation profile, imaging such as abdominal ultrasound or CT), informed consent, anesthesia evaluation (general or monitored anesthesia care), placement of an abdominal catheter into the peritoneal cavity and a central venous catheter in the internal jugular vein, tunneling and connection of catheters, verification of flow from peritoneum to central circulation, closure and postoperative monitoring for complications (infection, catheter dysfunction, bleeding, signs of heart overload). Postoperative follow‑up includes wound and catheter care, surveillance for disseminated intravascular coagulation or volume overload, and coordination with hepatology for ongoing ascites management.
Coding Specifications
| Modifier | Description | When to Use |
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