Neurosurgery Coding Alert

Question: Should 62367 be used for billing a Codman programmable V-P shunt?

Montana Subscriber

Answer: 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, and a coder specializing in surgical and neurosurgical procedures, says the Codman programmable V-P shunt is designed to provide easily adjustable control of intracranial and intraventricular pressure. It regulates the flow of cerebrospinal fluid from the ventricle of the brain to the peritoneum (where it can be absorbed). Code 62367 (electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; without reprogramming) refers to electronic analysis of the implantable intrathecal or epidural infusion pump, designed to provide pain-killing drugs at regulated intervals.

The programming function for the intrathecal pump (62368) involves checking the pump reservoir, testing and resetting the alarm if necessary, and managing prescriptions. The V-P shunt programming involves determining the optimal intracranial pressure and changing the valve settings with a magnetic controller. Both involve significant cognitive effort to determine optimal dosages or pressures, but the V-P shunt programs for only one variable (valve pressure) and doesnt include different dosages or times. Neither of these procedures is in any way analogous to 95970-95975, which are used for programming of implanted neurostimulator.

The reprogramming procedure itself is fairly simple: Enter the correct setting in the controller and then use a magnetic wand to change the valve setting. Most of the effort of the procedure is the cognitive work required to evaluate the symptoms indicating a need for adjustment and the determination of the optimal pressure setting. These are generally E/M services and are best billed with E/M codes. It is possible and appropriate to use 64999 (unlisted procedure, nervous system) and hope for adequate reimbursement, but it cannot be counted on since there is really no analogous code, not even 62368 (electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; with reprogramming), that includes the specific work listed above. If reprogramming is done during the global period for the pumps insertion, append modifier -24 (unrelated emergency and management service by the same physician during a postoperative period) to the E/M code.