# Dye study for pain pump catheter placement - help!



## sarthur (Feb 19, 2015)

How would you code from the following? We are going round in circles and cannot come up with anything that describes it well. Help?! 

History:This is a pleasant but unfortunate gentleman with a spinal cord injury and severe spasticity. The patient has an intrathecal baclofen pump, but has increasing spasms despite accelerating dosages of his intrathecal pump. We were called from the ER earlier this week and they were concerned about catheter malfunction. We have discussed with the patient and family the dye study utilizing catheter access port under fluoroscopic guidance and we discussed the potential need for re-programming after. 

Procedure: Intravenous access and monitors were applied. Procedure was discussed with patient. Questions were answered and consent was obtained. The patient was brought to the OR, placed supine, and sterile prep and drape done of the pump site using the template and live fluoroscopic guidance and the catheter access port was identified and it was instrumented after 2 attempts. Fluid/CSF 1.5mL was withdrawn from the catheter. The catheter was then injected with radiopaque contrast material. The catheter was traced into the spine. The patient was supine and the dye was spread posterior. There was concern of an epidural catheter placement. The myleogram was somewhat consistent with an epidurogram versus myleogram. At this point, the needle was removed. The patient's injection site was bandaged. He was taken to the recovery area. Vital signs were monitored and he was discharged to have a CT to determine intrathecal versus epidural dye spread. The patient was then sent to the office for reprogramming.


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## marvelh (Feb 19, 2015)

61070 and 75809 - 26 if performed in the facility

Per the August 2008 CPT Assistant:
Question: What is the appropriate code to report for implanted pump catheter dye studies? The patient is not getting pain relief, and an intrathecal catheter is evaluated for dislodgement, discontinuity, or kinking. Contrast is injected through the catheter with fluoroscopic guidance to identify a potential problem.

Answer: It is appropriate to report code 75809, Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation, for the radiologic supervision and interpretation (RSI) portion of such a procedure to evaluate for shunt catheter patency or leakage. This code can be used for evaluation of a variety of similar and related nonvascular shunt catheters and devices and requires the injection of contrast. Occasionally, evaluation for discontinuity is performed using plain radiography or CT imaging, without catheter contrast injection. In such cases, the service should be reported using appropriate radiography or CT codes describing which anatomical areas were imaged (eg, brain, neck, chest, and/or abdomen).

Implanted pump catheter dye studies typically require an injection component and an RSI component; therefore, it would also be appropriate for the physician performing the injection to report code 61070, Puncture of shunt tubing or reservoir for aspiration or injection procedure, to describe the injection service itself.


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## sarthur (Feb 20, 2015)

Thank you so much for your help, Marvel. You're the best! We had actually selected 61070 75809 but were over thinking it and kept wondering if it was the best code selection.


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