# Removal of VPS, and placement of EVD



## laruffin (Jan 2, 2014)

Hello, I need assistance with this Op note:  It was coded 62256, but I was thinking 62258 because the shunt was replaced with a drain in the same operative setting.
Any help is appreciated.


  VP Shunt Procedure:


Pre-operative diagnosis: Communicating hydrocephalus, recent VP shunt revision


Post-operative diagnosis: Same.


Operative Procedure: Removal of ventricular peritoneal shunt, placement of external ventricular drain.


Indications: This is an 34 y.o. female with complaints of altered mental status following a VPS revision.  Repeat CT head showed worsening communicating hydrocephalus.  The patient was taken to the OR for emergent removal of the VPS with placement of a ventricular catheter.  The potential risks of this operative intervention, including bleeding, infection, and damage to the brain resulting in stroke, paralysis, speech disturbance, visual loss, memory loss and death were all discussed.  After considering the potential risks of the operative intervention, the patient agreed to proceed. 


Operative Findings:  Distal VPS malfunction confirmed by flow of CSF through peritoneal catheter with removal of the catheter from the peritoneum.  Sponge, needle and instrument counts were correct at the conclusion of the case. Intravenous antibiotics where administered prior to the start of the case.


Operative implants:   External ventricular drain


Operative procedure in detail: After appropriate consent was obtained and history and physical were reviewed, the patient was taken from the preoperative holding area to the operating room and placed under general endotracheal anesthesia by the Anesthesia Service.  The patient’s head was positioned turned toward the left to expose the right parietal occipital bone. The patient was placed in semi-reverse Trendelenburg. The area was prepped widely along with the neck, the chest and abdomen on the right side with Hibiclens scrub, followed by DuraPrep. Sterile draping was performed in the routine fashion including split sheets and Ioban. The superior incision was reopened on the scalp and scalp edges were retracted with an angled Weitlander retractor.  The peritoneal catheter was withdrawn from the abdomen with flow of clear CSF briskly from the distal end.  The entire system was then removed, including ventricular catheter, valve, and peritoneal catheter.  A ventricular catheter was passed in trajectory toward the lateral ventricle and egress of fluid was visualized confirming placement within the fluid cavity.  Generous antibiotic irrigation was applied.  The catheter was then tunneled with trocar through a separate scalp incision.   A 3-0 Polysorb suture was placed in an inverted, interrupted fashion to reapproximate the galea of the scalp. The overlying skin edges then reapproximated with staples.  The scalp incision was covered with bacitracin ointment, Telfa, which was stapled to the scalp as a dressing.


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## yolanda.andrade@BSWHealth.org (Jun 24, 2021)

I have the case, does anyone have an idea, Im thinking the provider should bill 62258, the MD wants to bill 62256 and 62201. Please help.


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