# Shuntogram during pump revision



## betsycpcp (Nov 29, 2012)

Is is appropriate to code for a shuntogram when it's done in the midst a revision of a morphine pump?  

The op report lists these procedures and CPT codes: revision of pump and pump pocket 62362, revision of epidural catheter 62350, programming of pump 62368, refill of pump 95991, injection of catheter for myelogram 95991, shuntogram to locate tip of the catheter 75809.  The authorization request for the procedure also listed 61070 (puncture of shunt tubing for aspiration or injection).  

I work for a payer and I'm looking at the outpatient hospital bill.  They billed only 62350, 62362, 95991 (and C1772).  I know 62368 bundles with 62362, but I'm wondering if the hospital is considering 75809 (and 61070) to be included with 62350 and/or 62362.  Is it appropriate to bill those separately during this procedure? 

The op report shows that when the surgeon took the pump out of the pocket, there was a "fracture of the tubing right at the nipple where the nipple joins the catheter.  The first way I checked it was to see if it was dripping spinal fluid.  I then aspirated 0.5 mL of spinal fluid out and then injected approximately 5 mL of Isovue M200.  This showed that the catheter was intact and the tip was at about the level of the T12-L1 interspace."  He then goes on to describe removing the old medicine and refilling the pump, cutting off 5 cm of catheter where it was fractured and putting in an extension with a new nipple, suturing the pump into the pocket, irrigating and closing.

Any help will be appreciated.


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