Neurosurgery Coding Alert

Question: The surgeon placed a ventricular shunt to drain excess cerebrospinal fluid (62223). Three weeks later (during the global period of the shunt placement), the surgeon had to irrigate the proximal portion of the shunt due to blockage. May we report the irrigation separately and, if so, should we use a modifier? Washington, D.C., Subscriber Answer: Yes, you may bill separately for the shunt irrigation and, yes, you should use a modifier to indicate that the procedure took place during the post-operative period of the shunt placement (62223, Creation of shunt; ventriculo-peritoneal, -pleural, other terminus).

You should report 62225 (Replacement or irrigation, ventricular catheter) to describe the catheter irrigation. In this case, you should append modifier -78 (Return to the operating room for a related procedure during the postoperative period) to 62225.

Although you may be tempted to append modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) to 62225, you should not do so in this case. Modifier -58 indicates that the surgeon planned or anticipated the need for the irrigation procedure during the postoperative period. In your situation, the need for irrigation arises from an unexpected complication rather than because of routine or expected maintenance of the shunt.

- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CHC, CPC, compliance manager for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.