Summary & Overview
CPT 49428: Ligation of Peritoneal-Venous Shunt
CPT code 49428 denotes surgical ligation of an existing peritoneal-venous shunt, a targeted procedure to stop flow through a catheter system that drains the abdominal cavity into a neck vein. This intervention is clinically significant for patients with malfunctioning, infected, or otherwise contraindicated shunts and is relevant to hospitals and surgical centers nationwide. Billing clarity for this code affects reimbursement, coding consistency, and quality reporting for surgical and vascular teams.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The overview discusses national implications for coverage and coding practice rather than state-specific policies.
Readers will find a concise explanation of the clinical service represented by the code, guidance on typical sites of service, a review of common modifiers and payer relevance, and where available, benchmarking and policy context. The publication also highlights areas where input data is not available and directs readers to seek payer-specific policy documents for precise coverage rules. This summary equips coding professionals, hospital billing teams, and clinical leaders with a clear, high-level understanding of CPT code 49428 and its operational relevance in surgical practice.
Billing Code Overview
CPT code 49428 describes surgical ligation of an existing peritoneal-venous shunt, a procedure in which the provider ties off the shunt tubing that connects a catheter in the abdominal cavity to a catheter draining into a neck vein. The procedure is performed to stop the flow of fluid or material through the shunt.
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Service type: Surgical ligation of existing peritoneal-venous shunt
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Typical site of service: Hospital operating room or other surgical setting (inpatient or outpatient surgical facility depending on clinical context)
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a previously placed peritoneovenous (Denver) shunt for refractory ascites presents with signs of shunt-related complications, including recurrent infection at the catheter exit site and persistent ascites despite functioning drainage pathway. After multidisciplinary review, the surgical team schedules a brief operating room procedure to ligate the existing peritoneovenous shunt to stop flow through the device and eliminate the source of contamination. Preoperative evaluation includes review of prior imaging and operative reports, targeted labs, and informed consent documenting indication and risks. The patient receives local or general anesthesia per anesthesiology and surgeon preference. Intraoperatively the surgeon identifies the shunt tubing tract between the peritoneal cavity and the central venous catheter, isolates the externalized tubing, and ligates or clips the shunt to interrupt flow. Hemostasis is confirmed and the wound is closed. Postoperative workflow includes recovery monitoring, wound care instructions, infection surveillance, and documentation of device removal/ligation in the operative note and the medical record for billing and durable medical equipment reconciliation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Use when no special circumstance modifier applies |