Neurosurgery Coding Alert

Question: When performing the placement of a ventricular catheter and subcutaneous reservoir for chemotherapy, is 61210 (ventricular catheter) included in 61215 (reservoir)?

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Answer: The Correct Coding Initiative (CCI) 7.0, prohibits billing the code pair 61210 (Burr hole[s]; for implanting ventricular catheter, reservoir, EEG electrode[s], or pressure recording device [separate procedure]) and 61215 (insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular catheter). However, separate reimbursement may be possible, depending on the carrier, if both were not performed at the same time and were billed separately.

It may not be necessary (depending on a patients condition) to insert the subcutaneous reservoir at the same time the ventricular catheter is implanted. For example, a post-trauma patients intraventricular pressure may need to be temporarily monitored by placement of this catheter. Complications may arise requiring the insertion of the subcutaneous reservoir. A patients worsening condition may require a cessation of a procedure and the neurosurgeon may insert the subcutaneous reservoir later, when the patient is stable.

If the 61215 is billed separately, append modifier -58 (staged or related procedure or service by the same physician during the postoperative period) if the decision to later insert the subcutaneous reservoir was made at the time of the ventricular catheter implantation, or modifier -78 (return to the operating room for a related procedure during the postoperative period) if the insertion occurred at a later time.