CPT® Code 49324

The procedure described by CPT® Code 49324 involves the laparoscopic surgical insertion of a tunneled intraperitoneal catheter. This minimally invasive technique is performed to facilitate access to the peritoneal cavity for various therapeutic or diagnostic purposes. The procedure begins with the creation of a small incision near the umbilicus, through which a laparoscope—a thin, lighted tube equipped with a camera—is inserted. This allows the surgeon to visualize the abdominal cavity. To create sufficient working space, the abdomen is inflated with gas, typically carbon dioxide, which is known as pneumoperitoneum. Following this, two or three additional small incisions are made in the abdominal wall, and trocars, which are hollow tubes, are inserted to allow the passage of surgical instruments. During the procedure, the surgeon inspects the abdominal cavity for any adhesions and identifies the optimal site for catheter entry into the peritoneum. The tunneled intraperitoneal catheter is then attached to a tunneler, which is a specialized instrument designed to facilitate the placement of the catheter beneath the skin. The tunneler and catheter are advanced through the subcutaneous tissue, deep to Scarpa's fascia, until they reach the designated entry point for the catheter into the peritoneal cavity. Once positioned, the tunneler is removed, and an introducer needle is inserted into the peritoneum under laparoscopic guidance. A guidewire is then threaded through the introducer into the peritoneal cavity, allowing for the subsequent placement of a combined catheter introducer and dilator. This dilator is advanced over the guidewire into the peritoneum, after which both the guidewire and dilator are removed. The intraperitoneal catheter is then inserted into the abdomen through the introducer, and its proper positioning is confirmed via laparoscopic visualization. Finally, the introducer is withdrawn, the pneumoperitoneum is released, and the laparoscope along with the trocars are removed. The small incisions made during the procedure are then closed with sutures, completing the laparoscopic insertion of the tunneled intraperitoneal catheter.