# Abdominal Laparoscopy for VP shunt repositioning



## Joyce Burchett (Mar 21, 2011)

I have a general surgeon & neurosurgeon doing a laparoscopy for dysfunctional VP shunt secondary to migration peritoneal component into subcutaneous tissue.  Pt. has developed
a CSF seroma in subcutaneous tissue of the right upper quadrant. Extensive intra-abdominal adhesions found with virtually no free intra-abdominal space except over her liver.  Extensive dissection performed to open up the upper abdoment from the extreme left upper quadrant all the way across to the right upper quadrant to expose the area of tubing and the cyst. A small incision was created in the old site where the CSF cerumen was located. The tubing was discovered inferior to this in the subcutaneous tissue. Tubing was brought our & uncoiled. A counter incision was made approximately 10 cm to the right inferior. This was a 5 mm incision. A laparoscopic grasper was tunneled in the subcutaneous up through the cerumen incision and the tubing was brought down to that site. A Maryland dissector was then placed through the left upper quadrant port site, taken all the way across the abdomen through the base of the falcifor ligament, and up in an oblique fashion through the abdominal wall and out through the loswest right-side incision. The tubing was grasped, pulled back into the peritoneal cavity, across the right lobe of liver, through base of falciform ligament, and then draped over left lobe of liver & spleen.
Can anyone help with the CPT coding of this procedure.  Is 62230 the code I should use, or should I use ulisted lap code 49329 or 49320? 
Thanks!
Joyce Burchett, CPC


----------



## cmartin (Mar 23, 2011)

I think the 62230-62 is most appropriate.


----------

