# URGENT...need help with CPT for open placement of subarachnoid shunt



## consultingbykristin (Sep 12, 2012)

I need help with coding this case:

Open placement of subarachnoid shunt for external decompressive drainage

Details:

patient undergoing corrective lumbar spine surgery resulting in dural tear so a subarachnoid drainage shunt was requested by surgeon.

Patient was still under general anesthesia and still with sterile skin prep from the prior surgery, using an OEC 9800 fluoroscopic monitor, a 17-guage Tuohy needle passed through the skin at approximately 30 degrees at the level of the skin and directed into the right side of the posterior L5 vertebral space.  The ligamentum flavum was identified.  The epidural space was identified with a loss of resistance and a saline-filled plastic syringe.  The stylet was then replaced and the needle was then passed further into the subarachnoid space.  There was bloody-tinged cerebral spinal fluid flowing easily.  A 19-guage epidural tray (Smiths) passed easily without obstruction into the subarachnoid space, approximately 6cm.  The Tuohy needle and stylet were then removed and the injection hub was then screwed on to the end of the catheter.  there was clear unfettered flow of bloody-tinged cerebral spinal fluid.  The drainage catheter was then dried, the area prepped with Mastisol.  The catheter was then secured to the skin with 1-inch Steri-Strips.  the injection port was then secure to the tube with 1-inch Steri-Strips.  A PCA extension tubing was then placed at the port and connected to a biliary drainage bag in a sterile manner.  The connectors were all secure with a 1-inch Steri-Strips.  There was a smooth flow of the cerebral spine fluid.  The bag was marked as CSF drainage.


Dx Code:  997.09
CPT:  63740 v 63741

This was open placement but no laminectomy was done...would 63740 still be appropriate?


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## Virgie (Sep 12, 2012)

Hi ConsultingbyKristan,
     I have an older CPT book and I ordered my new books earlier but from looking at my book and the codes that you have questioned the codes are the same as my book.  Code 63740 is including laminectomy and you stated that no laminectomy had been done.  

Code 63741 is percutaneous, not requiring laminectomy.  
    Percutaneous means performed through the skin via needle.  

I myself would would code 63741.  Hopefully this will help you.


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## consultingbykristin (Sep 12, 2012)

Thanks for the help! I waivered back and forth on the codes....and agree that perhaps in this procedure 63740 is not appropriate but wasn't sure as I don't see this type of case often.


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## Virgie (Sep 12, 2012)

You are most welcome and have a great day


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