# External Ventricular Drain/ICP Monitor



## RebeccaWoodward*

Patient admitted with SAH

Burr hole was perfomed 12-9, no complications, taken to recovery room

*Postoperatively, 2 hours later, patient taken back to OR for cerebral edema, intracranial HTN*
Procedure:
1-Insertion of left frontal external ventricular drain
2-Insertion of left frontal intracranial pressure monitor

Previous incision from his left frontal burr hole was placement was reopened.  A self-retaining retractor was inserted.  The pia underlying the burr hole was coagulated with bipolar cautery and opened.  A left frontal external ventricular drain was placed on the first pass.  The external ventricular drain was brought out through a separate exit site in the skin, and secured there with a 2-0 silk suture.  It was then attached to drainage system.  A Codman intracranial pressure monitor wire was zero and introduced into the incision.  It was placed down the right frontal burr hole adjacent to the external ventricular drain into the brain parenchyma.  It was secured to the skin using a 2-0 silk suture............

My first thought was 61020.  Does anyone see anything else or have a different opinion?


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## RebeccaWoodward*

Anyone? 


Addendum....

Researching this further, 61210 is a better match.

Clinical Example (61210)

A 45-year-old male has a severe closed-head injury with a Glasgow Coma Scale score of 6 and no focal or lateralizing signs. The admitting computed tomography scan shows no hematomas or shift but obliteration of the basal cisterns. Intracranial pressure monitoring with capability for drainage of ventricular fluid is desired. A frontal ventriculostomy catheter is implanted and attached to an external monitoring and collection system.

Description of Procedure (61210)

A frontal scalp is made under local anesthesia. A twist drill hole is made, and a ventriculostomy catheter is introduced into the anterior horn of the lateral ventricle. The catheter is tunneled beneath the scalp for about 1-2 cm and then brought to the surface via a small stab wound. The catheter is connected to a pressure transducer and drainage tubing system. The system is calibrated to assure patency of the catheter. The scalp is then closed and dressings are applied.


Wish us luck...this is Medicaid.


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