Neurosurgery Coding Alert

Question: We followed AANS advice and billed an 'unlisted' code for Ommaya reservoir removal and ventricular-peritoneal shunt placement. The insurance company denied the claim and asked for a more specific procedure code. What is our best option?

Montana Subscriber

Answer: Your most accurate choice was the unlisted code. If the ventriculoperitoneal shunt placement involved placing the ventricular catheter at the site of the Ommaya reservoir, the reservoir removal may be considered incidental to ventriculoperitoneal shunt placement and not separately reportable. You'd code 10121 (Incision and removal of foreign body, subcutaneous tissues; complicated) when a surgeon treats penetrating injuries with retained foreign bodies.