Summary & Overview
CPT 49435: Abdominal Catheter Extension Tunneled to Upper Chest Exit
CPT code 49435 covers placement of an abdominal catheter extension that is tunneled subcutaneously to an upper chest exit site when performed during the same session as intraperitoneal cannula or catheter placement. This code documents an important step in establishing secure, long-term peritoneal access for therapies such as intraperitoneal medication delivery or dialysis and has implications for procedure reporting, device management, and facility billing nationally. Major payers addressed in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise explanation of the clinical service represented by the code, the typical sites of service, and the procedural context. The review summarizes payer coverage patterns and common modifiers used with this procedure where available, clarifies coding intent, and highlights billing considerations relevant to hospital and ambulatory surgical settings. The publication also outlines what benchmark metrics and policy updates are typically relevant for this type of device-placement procedure. Data not provided in the input are identified explicitly where applicable to guide further verification.
Billing Code Overview
CPT code 49435 describes placement of an abdominal catheter extension tunneled subcutaneously to an upper chest exit site performed at the same session as intraperitoneal cannula or catheter placement. The procedure involves extending an existing intraperitoneal access device to create a chest exit site, typically as part of establishing long-term peritoneal access.
Service type: Device placement / catheter extension
Typical site of service: Operative suite or procedure room in an inpatient or outpatient surgical setting
Clinical & Coding Specifications
Clinical Context
A patient with advanced malignancy or refractory ascites is scheduled for insertion of an intraperitoneal (IP) catheter for chronic intraperitoneal chemotherapy or long-term drainage. During the operative session the surgeon places the IP cannula or catheter into the peritoneal cavity and then constructs an abdominal catheter extension tunneled subcutaneously to an upper chest exit site to facilitate access, reduce infection risk at the abdominal wall, and allow secure external connection. Typical workflow: preoperative evaluation by surgical oncology or general surgery verifies indication (e.g., ovarian carcinoma requiring IP chemotherapy, malignant ascites), informed consent is obtained for catheter and subcutaneous tunneling, operating room setup with sterile field, induction of anesthesia (general or monitored anesthesia care), creation of laparoscopic or open peritoneal access, insertion of the intraperitoneal cannula/catheter, measurement and placement of extension tubing, creation of a subcutaneous tunnel from the abdomen to an upper chest pocket/exit, securement and dressing of the exit site, and documentation of catheter type, tunneling technique, laterality, and any intraoperative complications. Usual sites of service: ambulatory surgery center or hospital operating room. Typical providers: surgical oncologist, general surgeon, or gynecologic oncologist performing the procedure with nursing and anesthesia support.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use when no special circumstance modifier applies and procedure is routine |