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    OpenPayerBilling CodesPeritoneal-Venous Shunt ProceduresCPT cpt-49427-peritoneal-venous-shunt-contrast-injection-evaluation
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    CPT 49427: Peritoneal Venous Shunt Contrast Injection

    Medicare pays $36 on average nationally for this procedure.

    CPT code 49427 describes injection of contrast into the reservoir of an existing peritoneal venous shunt to evaluate flow through the shunt; this is an imaging/diagnostic injection procedure performed in a procedural suite, interventional radiology, or operating room setting and is used to assess patency and flow characteristics of the implanted peritoneal venous shunt.

    For related coverage guidance, see recent payer policy updates: Surgical Procedures, Outpatient Surgical Procedures - Site of Service, Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with an existing peritoneovenous (Denver-type) shunt implanted for refractory ascites who presents with signs of shunt malfunction (eg, recurrent abdominal distension, worsening edema, decreased urine output) or for routine evaluation after symptoms suggest poor flow. The patient is usually evaluated in an outpatient interventional radiology or specialty clinic. After review of history, physical exam, and prior imaging, the clinician explains that fluoroscopic contrast injection into the shunt reservoir will assess patency and directional flow.

    The procedure workflow: the patient is positioned on a fluoroscopy table; sterile prep and drape are performed over the subcutaneous shunt reservoir. Local anesthesia is applied and a small-gauge needle is used to access the reservoir. Contrast is injected under live fluoroscopy while the operator observes for antegrade flow into the venous system, retrograde leak into the peritoneal cavity, occlusion, or catheter fracture. Images and cine fluoroscopy are documented. If obstruction is identified, additional maneuvers (eg, thrombolytic infusion, catheter aspiration, or referral for revision) may be planned, but those are separate procedures and coded accordingly. Post-procedure monitoring occurs for a short period; discharge instructions include signs of infection and bleeding to report.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    49440Peritoneal venous shunt revision (eg, Denver shunt)Performed when contrast study demonstrates malfunction requiring revision; surgical repair or replacement follows diagnostic injection.
    76937Ultrasound guidance for vascular access and/or percutaneous proceduresMay be used for reservoir localization or guidance during needle access before contrast injection.
    36010Introduction of needle or intracatheter, venous, pressure measurement, or diagnostic venography access (diagnostic catheter placement)If venous catheterization or venography is performed in conjunction with contrast injection to assess central venous outflow, this code may be reported.
    49426Injection procedure for radiologic evaluation of ventriculoperitoneal shunt (radiologic evaluation of shunt) — note: anatomically different shunt typeOccasionally related when comparing shunt systems or when both peritoneal and ventriculoperitoneal systems are evaluated in a patient with multiple devices.
    76098Radiologic examination, contrast injection (eg, for fluoroscopic guidance), other than CT or MRMay be reported for additional radiographic documentation related to fluoroscopic contrast evaluation when separate from primary service.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    73Modifier 73 indicates a facility-level outpatient hospital or ASC procedure that was discontinued after the patient was prepared and taken to the procedure/operating room but before any anesthesia…- When to use: Apply CPT modifier 73 on the FACILITY (outpatient hospital or ASC) claim when the patient has been fully prepared and physically taken into the procedure/operating room but the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2084P0800X
    207L00000X
    2086S0102X
    363L00000X
    1710I1002X
    207VX0000X
    146M00000X
    207Y00000X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    I74.9Embolism and thrombosis of unspecified artery
    I80.9Phlebitis and thrombophlebitis of unspecified site
    I82.409Acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity
    I83.90Asymptomatic varicose veins of unspecified lower extremity
    I87.2Venous insufficiency (chronic) (peripheral)
    I96Gangrene, not elsewhere classified
    K57.20Diverticulitis of large intestine with perforation and abscess without bleeding
    K63.5Polyp of colon
    K65.0Generalized (acute) peritonitis
    K65.1Peritoneal abscess

    Showing 1–10 of 24

    Related Payer Policy Updates

    Specialty: General Surgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Surgical ProceduresUnitedHealthcare2026-09-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01
    Medical Necessity Guidelines — Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Ambulatory Surgery Center (ASC) - Site of Care PolicyKaiser Permanente2026-08-01

    Related Codes

    CPT-49425-PERITONEOVENOUS-SHUNT-PLACEMENT

    CPT 49425: Peritoneovenous Shunt Placement for Ascites

    CPT-49426-PERITONEAL-VENOUS-SHUNT-REPAIR-REPLACEMENT

    CPT 49426: Repair or Replacement of Peritoneal-Venous Shunt

    CPT-49428-PERITONEAL-VENOUS-SHUNT-LIGATION

    CPT 49428: Ligation of Peritoneal-Venous Shunt

    CPT-49429-PERITONEAL-VENOUS-CATHETER-REMOVAL

    CPT 49429: Peritoneal Venous Catheter Removal

    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

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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