Neurosurgery Coding Alert

Question: How would you code the ligation of a lumboperitoneal shunt? The procedure consists of an incision into the lumbosacral region to temporarily tie off the peritoneal catheter with sutures to prevent flow. After three days, it was determined that the patient would do well with removal of the shunt. The shunt was then permanently removed.
Washington Subscriber

Answer: The shunt ligation should be coded 63744 (replacement, irrigation or revision of lumbosubarachnoid shunt) and appended with a -52 modifier (reduced services) to indicate a minor revision. The shunt removal after three days would be coded 63746 (removal of entire lumbosubarachnoid shunt system without replacement) and appended with a -58 modifier (staged or related procedure or service by the same physician during the postoperative period) to indicate that the shunt removal was planned at the time of the ligation.

Editor’s note: The “Reader Questions” were answered by Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.