Anesthesia Coding Alert

CPT 61215 is more accurate

CPT Codes 2004 doesn't include a code specifically for Ommaya reservoir placement, which means you must choose between several surgical and anesthesia codes. Read on to learn how two experts answered the following reader question:

The physician performed an image-guided right- frontal Ommaya reservoir placement. The patient is undergoing systemic and intrathecal chemotherapy, and the physician requested the reservoir to facilitate her intrathecal chemotherapy (she has had difficulty with lumbar punctures). How should I code this procedure?"

Ommaya Placement Includes 2 Steps

Physicians use Ommaya reservoirs - implanted intraventricular devices - to retrieve samples of their patients' cerebrospinal fluid (CSF) or to administer medications (such as chemotherapy) directly to the CSF.

During the implantation, the surgeon creates a shunt to form a communicating duct from the lateral ventricles to the reservoir or drainage area (such as the atria, jugular veins or peritoneal space) to drain excess CSF or to administer medication.

The surgeon retracts the skin behind the patient's ear and drills a burr hole so he can insert the proximal portion of the shunt toward the lateral ventricles until CSF flows through the shunt. The physician may use an endoscope or neuroendoscope during this part of the procedure to place the Ommaya reservoir less invasively.

Once CSF flows through the shunt, the physician tunnels the opposite end of the shunt toward the drain site. He tests the shunt for flow or obstructions before closing the incisions.

Know When Your Coding May Change

"The problem in some cases might be that we're trying to assign one code to what is really two distinct procedures," says Julee Shiley, CPC, CCS-P, CMC, an anesthesia coding consultant in South Carolina. She recommends coding separately for reservoir and shunt placement as applicable.

Some physicians report 62360 (Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir) for reservoir placement, but Shiley isn't sure this is the best coding option for Ommaya reservoirs.

"I believe 61215 (Insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular catheter) is the most appropriate code," she says. "One reason is because 61215 is in the most appropriate section of CPT to describe the procedure; second, this code represents an intracranial procedure versus a spinal epidural or intrathecal infusion as 62360 reports. Both distribute medications into the CSF, but I think 61215 is more accurate."

Choose Among Anesthesia Codes

Crosswalk lists several anesthesia codes that correspond to 61215, but 00214 (Anesthesia for intracranial procedures; burr holes, including ventriculography) is the most appropriate, Shiley says, because the surgeon must drill a burr hole for the ventricular catheter (shunt) connection. Report alternative code 00220 (... cerebrospinal fluid shunting procedures) instead only if the physician places the reservoir under the scalp.

Some coders report 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified). "This might be useful when the Ommaya is placed in the lumbar or lumbothoracic region," says Kelly Dennis, CPC, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla. "But it seems like a very low base for the procedure. I believe 00214 or 00220 is more appropriate for the anesthesiologist to use."

Shunt Placement

Although your physician's documentation might include details regarding shunt placement and fluoroscopic guidance, the anesthesiologist most likely did not perform them, so you won't need to assign codes to those parts of the procedure.

Because some neurosurgeons report only the reservoir placement (not the shunt placement), Shiley sometimes bases her anesthesia code on 62220 (Creation of shunt; ventriculo-atrial, -jugular, -auricular) or 62223 (... ventriculo-peritoneal, -pleural, other terminus). Both codes cross to 00220 (Anesthesia for intracranial procedures; cerebrospinal fluid shunting procedures), totaling 10 base units.