Radiology Coding Alert

Question: How can we report shuntography for a non-vascular ventriculoperitoneal shunt? Can we submit code 36147 or 75791?

Ohio Subscriber

Answer: Before you select the right code for shuntography, you need to determine the site of puncture in the shunt for the procedure. Here are the possible codes you can submit when your physician evaluates a ventriculoperitoneal (VP) shunt:

When your physician administers injections via the VP shunt port, you submit code 75809 (Shuntogram for investigation of previously placed indwelling nonvascular shunt [e.g., LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump], radiological supervision and interpretation).

When your physician injects via the abdominal reservoir, you submit code 49427 (Injection procedure [e.g., contrast media] for evaluation of previously placed peritoneal-venous shunt). This code is for evaluation of a previously placed PV shunt.

For a skull area injection, you submit code 61070 (Puncture of shunt tubing or reservoir for aspiration or injection procedure).

You should not submit code 36147 (Introduction of needle and/or catheter, arteriovenous shunt created for dialysis [graft/fistula]; initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report [includes access of shunt, injection(s) of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava]) or 75791 (Angiography, arteriovenous shunt [e.g., dialysis patient fistula/graft], complete evaluation of dialysis access, including fluoroscopy, image documentation and report [includes injections of contrast and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava], radiological supervision and interpretation). These codes are for imaging of vascular shunts, for example an arteriovenous dialysis fistula.

Note: When your physician evaluates the CSF flow in the shunt, you submit code 78645 (Cerebrospinal fluid flow, imaging [not including introduction of material]; shunt evaluation).