Neurosurgery Coding Alert

Remember: Don’t mix up shunt tap with shunt irrigation.

When your neurosurgeon performs a ventriculoperitoneal shunt tap, you must check the medical documentation for specific details including whether he performed radiological supervision and if he performed an evaluation and management service during the same patient encounter.

Read on to learn more.

Know What Happens during Ventriculoperitoneal Shunt Tap

When your neurosurgeon performs a ventriculoperitoneal shunt tap, you should report code 61070 (Puncture of shunt tubing or reservoir for aspiration or injection procedure) for this service.

Ventriculoperitoneal shunt tap explained: During this procedure, your neurosurgeon will use a syringe and butterfly needle, sometimes along with a three-way stopcock and manometer. Your neurosurgeon may perform a ventriculoperitoneal shunt tap to analyze cerebrospinal fluid (CSF) to rule out infection, use a manometer to take an intracranial pressure measurement to rule out hydrocephalus, and observe distal flow rate to rule out distal shunt obstruction.

You Can Report 61070 for Shunt in Either Tubing or Reservoir

You can report 61070 whether your neurosurgeon performs the puncture or tap in the tubing of the shunt or the reservoir of the shunt. Your neurosurgeon may choose a site for puncture to confirm a site of obstruction in the shunt.

For example, according to the medical documentation, your neurosurgeon used a three-way stopcock and manometer during the shunt tap. During this procedure, your neurosurgeon focused on intracranial pressure measure with manometry and/or documentation of the flow. This information tells you your neurosurgeon was trying to locate an obstruction in the shunt.

Aspiration or injection: You can also report 61070 if your neurosurgeon attempts an aspiration or injection of the shunt. Although aspiration of CSF fluid is more commonly performed, your neurosurgeon may also inject antibiotics to treat an infection or inject an imaging dye to evaluate the shunt’s integrity, says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

Don’t Forget to Check for E/M Services

If your neurosurgeon also performed an E/M service for the shunt before making the decision to perform a tap, you may be able to apply modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code on the day of the shunt tap.

Note: You must check the medical documentation to confirm that your neurosurgeon made the decision to tap the shunt during that same patient encounter. So, in this case, the neurosurgeon is performing an E/M service, which leads to the decision to perform the shunt tap procedure.

Differentiate Between Shunt Irrigation and Tap

When you are reporting for shunt taps, make sure you don’t confuse this service with a shunt irrigation. For shunt irrigation you would report code 62225 (Replacement or irrigation, ventricular catheter) or code 62230 (Replacement or revision of cerebrospinal fluid shunt, obstructed valve, or distal catheter in shunt system) for ventricular irrigation. These two codes describe the proximal and distal portions of the ventriculoperitoneal catheter. These two procedures are typically done in the operating room, whereas the shunt tap can be performed at the bedside or in the office.

Don’t miss: If your neurosurgeon replaces both the ventricular catheter and the distal catheter, then you should report 62258 (Removal of complete cerebrospinal fluid shunt system; with replacement by similar or other shunt at same operation).

Include Radiological Supervision on Your Claim

radioactive isotope into the shunt reservoir. The neurosurgeon then measures the speed with which the isotope travels. Your neurosurgeon may interpret the delayed movement of the isotope as a problem in the shunt and may decide an intervention is needed based upon the interpretation. You should report code 61070, 75809 on your claim. You would also apply modifier 26 (Professional component) to code 75809, since it is unlikely that your neurosurgeon owns the radiological equipment to monitor the isotope movement. In the CPT^® manual, you will find a note under code 61070, which instructs you to report 75809 (Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation) for radiological supervision and interpretation, if your neurosurgeon performs this service.

Coding example: Your neurosurgeon supervises a ventriculoperitoneal shunt tap, along with a shuntogram, which is a radiological study where he introduces a radioactive isotope into the shunt reservoir. The neurosurgeon then measures the speed with which the isotope travels. Your neurosurgeon may interpret the delayed movement of the isotope as a problem in the shunt and may decide an intervention is needed based upon the interpretation. You should report code 61070, 75809 on your claim. You would also apply modifier 26 (Professional component) to code 75809, since it is unlikely that your neurosurgeon owns the radiological equipment to monitor the isotope movement.