Neurosurgery Coding Alert

Question: Our surgeon performed an irrigation of the ventricular catheter through a percutaneous puncture. In addition, our surgeon revised the distal catheter through a separate exposure. How can we report these services? Can we submit 62258 for the revision in catheter?

Florida Subscriber

Answer: Submit code 61070 (Puncture of shunt tubing or reservoir for aspiration or injection procedure) for the ventriculoperitoneal shunt irrigation. Additionally, report code 62230 (Replacement or revision of cerebrospinal fluid shunt, obstructed valve, or distal catheter in shunt system) for replacement of the distal catheter.

Beware the bundle:  Note that Correct Coding Initiative (CCI) column 2 edits exist for 61070 and 62230, so you’ll append modifier 59 (Distinct procedural service) to 61070 if you report this code with 62230. If the surgeon performs ventricular catheter irrigation through the same exposure as the distal shunt revision, then the irrigation would be considered a bundled service.

Tip: Always append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to any evaluation and management (E/M) code for services your physician might perform on the day of the shunt tap — provided your surgeon examined the shunt and made a decision to perform a tap in the shunt during that encounter.

62258 is not the right choice: Do not confuse codes 62225 (Replacement or irrigation, ventricular catheter) and 62230 (Replacement or revision of cerebrospinal fluid shunt, obstructed valve, or distal catheter in shunt system) with that for a ventriculoperitoneal shunt tap. These two procedure codes describe the proximal and distal portions of the ventriculoperitoneal catheter, respectively. If the surgeon replaces both the ventricular catheter and the distal catheter, then the appropriate code to report is 62258 (Removal of complete cerebrospinal fluid shunt system; with replacement by similar or other shunt at same operation).

More about 61070: Here are three key points to keep in mind to avoid losing earned payment for ventriculoperitoneal tapping:

1. You can bill for shunt tap for an inpatient within the global period for shunt placement.
2. You can report 61070 regardless of whether your surgeon approaches the shunt tubing or the reservoir.
3. You can report 61070 regardless of whether your surgeon attempts an aspiration or injection of the shunt.