CPT 49426 Peritoneal Venous Shunt Repair Reimbursement | OpenPayer

Summary & Overview

CPT 49426: Repair or Replacement of Peritoneal Venous Shunt

CPT code 49426 represents the surgical repair or replacement of an existing peritoneal venous shunt identified as malfunctioning. This procedure addresses device failure, obstruction, leakage, or other shunt-related complications that require operative intervention. Nationally, procedures to correct implanted vascular shunts are significant for hospitals and surgical centers due to their implications for patient safety, device management, and post-procedure resource use.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The content outlines coverage and billing considerations as they typically relate to these national payers and public programs.

Readers will find a concise clinical and coding overview, typical sites of service, and expected service descriptors for CPT code 49426. The publication also summarizes benchmarks where available, highlights relevant policy or coverage issues that commonly affect claims for shunt repair or replacement, and explains clinical context such as indications for intervention. Data not available in the input is noted where applicable. The goal is to provide clinicians, coders, and policy professionals a clear national-level reference for identifying when CPT code 49426 applies and what dimensions of coverage and documentation are most often relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare49426CPTshunt repairperitoneal venous shuntsurgical proceduredevice managementoperating roomambulatory surgical center

Billing Code Overview

CPT code 49426 describes a procedure in which a provider repairs or replaces an existing peritoneal venous shunt after identifying a problem in the implanted device. This service is surgical correction of an existing peritoneal venous shunt and typically involves operative exploration, repair of malfunctioning components, or replacement of portions of the shunt system.

Service type: Surgical repair or replacement of an implanted peritoneal venous shunt
Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with a previously placed peritoneovenous (Denver-type) shunt for refractory ascites presents with signs of shunt malfunction: recurrent abdominal distension, increasing lower extremity edema, and hypotension. Imaging (abdominal ultrasound and shunt series) demonstrates discontinuity of the subcutaneous tubing and proximal catheter migration with impaired flow. The interventional surgeon evaluates the patient in the hospital setting, confirms a mechanical failure of the existing shunt, and schedules operative repair/replacement. Under general anesthesia in an operating room, the surgeon exposes the existing shunt tract, identifies the defective segment, removes or replaces the damaged tubing and/or valve, reinstalls secure catheter connections and tests patency before closure. Postoperative care includes monitoring fluid balance, vital signs, and signs of infection; the patient typically remains in the hospital for observation until hemodynamically stable and ascites control is confirmed.

Coding Specifications

Modifier	Description	When to Use
`00`	Service not specified in other modifiers (placeholder)	Rarely used; included when no other modifier applies and payer requires a default code.
`11`

CPT 49427: Contrast Injection for Peritoneal Venous Shunt Evaluation

CPT-49425-PERITONEOVENOUS-SHUNT-PLACEMENT

CPT 49425: Peritoneovenous Shunt Placement

CPT-49428-PERITONEAL-VENOUS-SHUNT-LIGATION

CPT 49428: Ligation of Peritoneal-Venous Shunt

CPT-49429-PERITONEAL-VENOUS-CATHETER-REMOVAL

CPT 49429: Removal of Peritoneal Venous Catheter

CPT-49435-ABDOMINAL-CATHETER-EXTENSION-TUNNELED-UPPER-CHEST-EXIT

CPT 49435: Abdominal Catheter Extension Tunneled to Upper Chest Exit

CPT-49436-EXIT-SITE-CREATION-FOR-INTRAPERITONEAL-CATHETER

CPT 49436: Exit-Site Creation for Intraperitoneal Catheter

Taxonomy Code	Specialty	Notes
2080S0003X	General Surgery	Most repairs/replacements of peritoneovenous shunts are performed by general surgeons with abdominal operative expertise.
208600000X	Vascular Surgery	Vascular surgeons may perform repairs when venous outflow or complex vascular reconstruction is required.
2084P0800X	Pediatric Surgery	Pediatric surgeons perform shunt repairs in pediatric patients when applicable.
207RC0000X	Interventional Radiology	Interventional radiologists may perform image-guided assessments and percutaneous revisions or exchanges of components prior to open repair.
207L00000X	General Practice (Hospitalist/Surgicalist)	May be involved in inpatient pre/postoperative management but typically do not perform the operative repair.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32998`	Repair of pleuroperitoneal shunt, open; complicated	May be used for thoracic-peritoneal shunt repairs when pleural components are involved; similar principles apply to peritoneovenous shunt repair when chest involvement exists.
`49422`	Removal of implanted peritoneovenous shunt with or without replacement	Performed when full removal and replacement of the shunt is required rather than limited repair; often billed when the entire device is exchanged.
`49568`	Repair of abdominal wall hernia, recurrent; complicated	May be reported when concurrent complex abdominal wall reconstruction is required during shunt exposure or repair.
`36478`	Endovenous ablation, thermal; proximal (e.g., saphenous vein)	Not directly related but represents venous procedures that vascular surgeons might perform in the same operative session if venous access/issues are concurrent.
`76000`	Fluoroscopy (separate procedure)	Fluoroscopic guidance may be used intraoperatively to assess catheter position or patency; billed as an imaging adjunct when performed.

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