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In the following example, how would it change if only a fibrin sheath was demonstrated and the tPA was injected but the brush wire was not used. Everything else the same. 2011 case. 1) Patient with a poorly functioning peritoneal dialysis catheter presents for evaluation. In a sterile fashion, the tube is injected with contrast and evaluation of the peritoneal cavity is performed (49400, 74190), demonstrating fibrin sheath around the catheter and multiple adhesions in the abdominal cavity. 8 mg tPA is mixed with saline and injected through the catheter. After thirty minutes, the area is reevaluated, and a wire is placed through the catheter with subsequent disruption of the fibrin sheath (49999, 76496). A repeat injection demonstrates free spill of contrast throughout the peritoneal space.