AHA Coding Clinic® for HCPCS - 2025 Issue 4; Ask the Editor

Diagnostic Laparoscopy with Peritoneal Dialysis Catheter Irrigation

A patient presented for diagnostic laparoscopy and possible revision of a peritoneal dialysis catheter due to inadequate drainage. After induction of general anesthesia, the abdomen was insufflated via the peritoneal dialysis catheter without issue. A 5 mm incision was made in the left upper quadrant down to the deeper tissues, and a 5 mm trocar was placed. A 5 mm laparoscope was then inserted.Brief inspection of the peritoneal cavity revealed no obvious pathological abnormalities. The catheter did not appear to be clotted, obstructed with debris, or entangled in the small bowel.A second 5 mm port was placed, and a grasper was used to examine the catheter, confirming no lumen obstruction. The insufflation tubing was connected to the camera port, and one liter of saline was instilled rapidly through the peritoneal dialysis catheter. The fluid was allowed to drain by gravity, with immediate return noted.The abdomen was de-sufflated, and the remaining fluid drained. The fluid was then disconnected and the insufflation was reconnected to the peritoneal dialysis catheter, and the abdomen was re-insufflated. The catheter lay in good position in the right lower quadrant and was flushed.Would it be appropriate to report both the peritoneal dialysis catheter irrigation and CPT code 49320 for the diagnostic laparoscopy or would only the irrigation be reported? ...

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