CSF Shunt Placement

Updated: Jul 14, 2023

What is it?

A #ventriculoperitoneal shunt (VPS) is a surgical treatment for hydrocephalus. Hydrocephalus is a neurological disease literally meaning water on the brain and can be very disabling. This fluid (#cerebrospinal fluid or CSF) is normally made then reabsorbed at certain rates and when these rates are not balanced, it can lead to an increase in fluid causing pressure and resulting in #neurologic symptoms.

CSF normally resides in cavities in the brain called ventricles. The purpose of a VPS is to drain this excess fluid from the ventricle. This is achieved by placing a tube into the ventricle (in the brain) which drains the fluid to the abdomen. There is typically a valve which prevents the fluid from moving in the wrong direction and only lets fluid drain when the pressure is too high.

CSF SHUNT

What is its goal?

The goal of a ventriculoperitoneal shunt (VPS) is to reduce the abnormally #high pressure inside the brain. This is achieved by placing a catheter in the brain that allows #drainage of excess fluid into the #abdomen

How is it done?

The patient goes to sleep with general #anesthesia. A small hole is made in the skull on the top of the head, behind the hairline. A small catheter is directed into the fluid filled cavity in the brain (ventricle). Tubing is tunneled to a place behind the ear where a valve is placed to regulate the flow of fluid. Tubing is again tunneled down to the belly (peritoneum) where the fluid can drain freely and be absorbed by the body. The surgery usually takes around an hour and a half to perform.

How to code CSF Shunt:

Look for proximal and terminal placement:

If you can find out what portion of the brain a shunt drains, and the location it drains into, you can code all shunt procedures with ease.

1. Determine Where the Shunt Begins and Ends Before selecting a code for initial shunt placement, you should read the surgeon's documentation to determine the locations of both the #proximal (beginning) and terminal (drain site) portions of the shunt.

To treat obstructive #hydrocephalus, the surgeon places an extra-cranial shunt or tube to drain fluid from the #ventricles of the brain to another body area, The surgeon locates the proximal end of the shunt through a burr hole into the selected area of the brain and advances the distal portion of the shunt to the drain site.

For #Endoscope #Placement, Claim the Add-On Code If the surgeon places a ventricular shunt (62220 or 62223) using the #neuroendoscope, you may report add-on code +62160 (Neuroendoscopy, #intracranial, for placement or #replacement of ventricular catheter and attachment to shunt system or external drainage [list separately in addition to code for primary procedure]) in addition to the code for the primary procedure. For example, the #surgeon places a ventricular shunt routed to the #pleural cavity using the endoscope. In this case, you should report both 62223 and 62160.

3. Report Revisions Separately Extra cranial shunts may require periodic revisions or maintenance, which you may report separately.

Typically, shunts become blocked at one of three places: the ventricular catheter, the valve that controls the flow of fluid, or the distal tubing

By knowing the blockage location and the shunt type, and using the chart below, you can easily select the appropriate revision code.

#CPT also includes 62252 for reprogramming of programmable CSF shunt. The reprogrammable shunt allows noninvasive pressure adjustments to correct over- or under-drainage of CSF.

According to CPT Changes 2001: An Insider's View, published by the AMA, you should report 62252 "one time only for each encounter" regardless of the number of parameters the surgeon adjusts. 4. Select 62256, 62258 for Complete Removals When the surgeon removes a complete shunt system, you should select 62256 (Removal of complete CSF shunt system; without replacement) or 62258 (... with replacement by similar or other shunt at same operation) if the surgeon also replaces the shunt system