Neurosurgery Coding Alert

Question: The surgeon's operative report states "ventriculoscope to fenestrate the 3rd ventricular tumor cyst" and placement of VP shunt. Should I report 62223 (Creation of shunt; ventriculo-peritoneal, -pleural, other terminus)? Is there an additional code I should report with this?

Georgia Subscriber

Answer: There are a series of codes describing use of a ventriculoscope or neuroendoscope (which is the CPT term). Although these codes include placement with removal of a ventricular catheter, it does not include performance of a ventriculoperitoneal shunt placement. The challenge in coding this procedure involves accounting for the overlap between the cyst fenestration that includes ventricular catheter placement and the ventriculoperitoneal shunt placement that also includes the ventricular catheter placement.

Appending modifier 52 (Reduced services) on placement of the ventriculoperitoneal shunt placement code 62223 would account for the overlap of services. In summary, you would report:

• 62161 - Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts (including placement, replacement, or removal of ventricular catheter)
• 62223-52, -51 - Creation of shunt; ventriculo-peritoneal, -pleural, other terminus