Neurosurgery Coding Alert

Question: One of our surgeons is looking at placing a "VENTRICULO-PERITONEAL" baclofen pump. We are looking at using 62223 (Creation of shunt; ventriculo-peritoneal, -pleural, other terminus) and 62362 (Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming). The idea of the pump is that the medication gets directly dispersed in the brain not the spine. Please opine of our choice of codes.

Wisconsin Subscriber

Answer: It is difficult to understand a scenario in which a pump is placed for intrathecal cranial infusion but a catheter system is placed between the ventricle and peritoneum. Infusion pumps and catheters are by nature unidirectional to a site(s). Code 62362 is applicable for spinal infusion pumps, but not pumps for cranial infusion. If the procedure performed was a ventricular catheter placement for intrathecal cranial infusion from an implantable pump, you would report 61215 (Insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular catheter) for the pump placement and 61210 (Burr hole[s]; for implanting ventricular catheter, reservoir, EEG electrode[s], pressure recording device, or other cerebral monitoring device [separate procedure]) for placement of the ventricular catheter through a burr hole for infusion. The latter code would be appended with the 51 (Multiple procedures...) modifier.