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Neurosurgery Coding Alert

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Retained Shunt Tubing

Published on Tue May 01, 2001

Question: A patient underwent a shunt revision. The shunt was converted from a ventriculo-peritoneal to a ventriculo-pleural. The peritoneal tubing was disconnected from the valve and new distal tubing was placed in the pleural cavity. Is 64999 appropriate for removal of retained shunt tubing? Or should I use 20670 or some other code?

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Answer: Unlisted procedure code 64999 should only be used if no other one better describes the procedure. Code 20670 (removal of implant; superficial, [e.g., buried wire, pin or rod] [separate procedure]) is indicated for skeletal implants. Code 49422 (removal of permanent intraperitoneal cannula or catheter) would be more specific and accurate for billing this situation because it directly refers to the intraperitoneal cannula or catheter.

Note: CPT 2001 guidelines do not indicate whether the distal catheter removal would be considered part of 62230 (replacement or revision of CSF shunt, obstructed valve, or distal catheter in shunt system), but it is not bundled, according to CCI edits.
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