Summary & Overview

CPT 49436: Exit-Site Creation for Intraperitoneal Catheter

CPT code 49436 covers the surgical creation of an exit site for an already implanted subcutaneous segment of an intraperitoneal cannula or catheter. This targeted procedure facilitates external access for intraperitoneal devices used in therapies such as chronic dialysis or intraperitoneal medication delivery. Its proper coding matters nationally because accurate reporting affects clinical documentation, device management workflows, and payment for a commonly needed maintenance procedure in patients with long-term peritoneal access.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the procedure and its clinical context, guidance on typical places of service, and a mapping of commonly used modifiers and related billing considerations. The publication also summarizes benchmark topics and policy implications relevant to payers and providers, including coding clarity for device-related surgical site establishment, common billing modifiers used with the code, and implications for facility versus professional billing.

This national-level summary is intended for coding professionals, clinicians who manage intraperitoneal catheters, and payer policy teams seeking a clear reference for CPT code 49436. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 49436intraperitoneal catheterexit site creationsurgical proceduredevice managementambulatory surgerycoding and billingperitoneal access

Billing Code Overview

CPT code 49436 describes a surgical procedure in which the provider makes an incision to create an exit site for an already installed subcutaneous segment of an intraperitoneal cannula or catheter. This procedure establishes or revises the external opening through which an indwelling intraperitoneal catheter exits the skin.

Service type: Surgical incision for catheter exit-site creation/revision
Typical site of service: Ambulatory surgical center or hospital operating room; may also be performed in an outpatient procedure or interventional suite depending on clinical setting

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with end-stage renal disease has an indwelling intraperitoneal dialysis catheter with a subcutaneous tunneled segment placed previously. The patient presents for creation of a formal external exit site because the catheter was initially buried (subcutaneous) or the existing exit site has migrated or closed. The procedure is performed in an outpatient minor procedure room, ambulatory surgery center, or hospital operating room under local anesthesia with sedation or general anesthesia when clinically indicated. The workflow includes pre-procedure verification of catheter position (imaging review or fluoroscopy as needed), sterile preparation, a small incision to externalize the subcutaneous segment and fashion a clean exit site, hemostasis, catheter stabilization and dressing application, brief post-procedure recovery with discharge instructions on exit-site care and follow-up.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Use when no special circumstances apply.
`11`	Physician or other qualified health care provider service	Use for the usual, uncomplicated service when reporting professional component in systems that require it.

Taxonomy Code	Specialty	Notes
208000000X	General Surgery	General surgeons commonly perform catheter exit-site creation and revisions.
207P00000X	Vascular Surgery	Vascular surgeons perform tunneled catheter externalizations and complex revisions.
207L00000X	Interventional Radiology	Interventional radiologists may externalize catheters under imaging guidance.
207K00000X	Urology	Urologists may be involved when peritoneal access intersects urologic procedures.
163W00000X	Nephrology	Nephrologists coordinate peritoneal dialysis catheter management and may perform minor externalizations in some settings.

CPT Code	Description	Relationship to This Procedure
`74370`	Computed tomography, abdomen and pelvis; without contrast material (Note: imaging codes vary)	May be used pre-procedure to evaluate catheter location or complications when cross-sectional imaging is required.
`49422`	Removal of tunneled intraperitoneal catheter, requiring cutdown, with or without subcutaneous tunneling	Performed when a tunneled catheter must be removed rather than exteriorized; may precede or follow exit-site procedures.
`49424`	Revision, repair, or replacement of peritoneal dialysis catheter, open; requiring replacement of portion of catheter	Used for more extensive catheter revisions beyond simple exit-site creation.
`49440`	Repositioning of tunneled intraperitoneal catheter, open; requiring laparotomy or extensive operative approach	Performed when internal repositioning is required in addition to exit-site creation.
`49439`	Other maintenance procedures on intraperitoneal catheter (e.g., trimming, repair)	Used for minor catheter maintenance performed at the same encounter or in follow-up.

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