Inpatient Facility Coding & Compliance Alert

Question: The surgeon placed a shunt to treat a patient’s hydrocephalus. How should we code the case?

Vermont Subscriber

Answer: You have several code choices for hydrocephalus diagnosis and treatment, which are hard to pinpoint without more details. Keep these things in mind as you choose the most appropriate codes.

Diagnosis: First, determine which type of hydrocephalus the doctor diagnosed. If it’s acquired, the physician should document whether it’s communicating (331.3) or non-communicating (331.4, Obstructive hydrocephalus). Congenital hydrocephalus is coded as 742.3. Yet another type is idiopathic normal pressure hydrocephalus (or normal pressure hydrocephalus), which you report with 331.5. If the physician documents an acquired stenosis or if he doesn’t specify the type, choose 331.4 for acquired hydrocephalus, not otherwise specified.

Treatment: Hydrocephalus needs to be treated to improve the flow of cerebrospinal fluid (CSF) and reduce or prevent brain damage. A shunt can be inserted into one of the brain ventricles and tunneled under the skin, with the other end inserted into the abdomen or heart to keep the CSF moving in the right direction at the correct rate. Select the most appropriate shunt placement code from these options:

02.34 (Ventricular shunt to abdominal cavity and organs) -- This shunt is inserted from the brain to the abdomen or peritoneum. Documentation might mention a ventriculoperitoneal shunt. Procedure code 02.34 also includes ventriculocholecystostomy and ventriculoperitoneostomy.

02.22 (Intracranial ventricular shunt or anastomosis) -- Assign 02.22 for ventriculostomy, a procedure that creates a hole at the bottom of the ventricle or between two ventricles to drain CSF from the brain. A ventriculostomy by an external ventricular drain also is classified to code 02.21.