# Irrigation of Intrathecal Cath



## jlb0807 (May 14, 2013)

Hello!

I was wondering if I could get some help coding this procedure. I've been filling in for our pain management client since they don't have a coder and both my administrator and I are stumped on this. Please help!

Thanks in advance!

Pre-OP DX: Need for catheter evaluation

Post-OP DX: Same

Procedure Preformed: Irrigation of intrathecal catheter system with catheter evaluation; intraoperative myelogram

Anesthesia: IV/MAC

Description of Procedure: Following informed consent, the patient was taken to the procedure room and placed in the supine position. All noninvasic monitors were applied. She was prepped and draped in sterile field. Under C-arm fluoroscopic guidance, a 25 guage Huber needle was inserted into the side port of her SynchroMed infusion pump and connected to tubing and syringe full of Omnipaque 300 contrast was used to flush of all air. I then aspirated approximately 2 mL of clear cerebral spinal fluid from the catheter system. This was followed by injection of Omnipaque contrast to run 2-3 mL, demonstrating good myelographic spread. I then flushed the system with preservative free saline. She will be bolused with 0.2 mL postoperatively to clear the side port and the catheter system. 




The Doctor marked 62284, 95999, 72265 and 77003. Any advice? Thanks again!


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## dwaldman (May 14, 2013)

The procedure note provided does not support 62284 72265. 77003 would not be reported in addition to 72265. Not familiar with 95999. Below is from AMA CPT Assistant, where they describe intrathecal catheter evaluation. But the procedure note provided does not mention the integrity  of the catheter after contrast administration.


July 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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