Neurosurgical Reimbursement Codes To Our Partners in Healthcare Medtronic has compiled this coding guide as part of our mission to help you with the diagnosis and treatment of various neurological conditions, including hydrocephalus, subdural hematomas, dural lesions, and intraventricular abnormalities. The information in the guide provides general reimbursement information to assist in obtaining coverage and reimbursement for healthcare services. These coding suggestions do not replace seeking coding advice from the payer and/or your own coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. PHYSICIAN CODING AND REIMBURSEMENT Procedure Shunt and Catheter Implantation and Replacement Adjunctive Services for Shunt Implantation Shunt Removal Shunt Patency Evaluation Shunt Reprogramming CPT Description 61107 Twist drill hole(s) for ventricular puncture for implanting ventricular catheter 61120 Burr hole(s) for ventricular puncture (including injection of gas, contrast media, dye, or radioactive material) 61210 Burr hole(s) for implanting ventricular catheter 61215 Insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular catheter 62180 Ventriculocisternal shunting 62190 Creation of shunt; subarachnoid/subdural-atrial, -jugular, -auricular 62192 Creation of shunt; subarachnoid/subdural-peritoneal, -pleural, other terminus 62194 Replacement or irrigation, subarachnoid/subdural catheter 62220 Creation of shunt, ventriculoatrial, ventriculojugular, ventriculoauricular 62223 Creation of shunt, ventriculoperitoneal, ventriculopleural, other terminus 62225 Replacement or irrigation, ventricular catheter 62230 Replacement or revision of CSF shunt, obstructed valve or distal catheter in shunt system 62258 Removal of complete CSF shunt system with replacement 63741 Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other percutaneous, not requiring laminectomy 61781 Stereotactic computer- assisted (navigational) procedure, cranial, extradural (List separately in addition to primary procedure) 61782 Stereotactic computer- assisted (navigational) procedure, cranial, extradural (List separately in addition to primary procedure) +62160 Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage 62256 Removal of complete CSF shunt system without replacement 61070 Puncture of shunt tubing or reservoir for aspiration or injection 75809-26 62252 Shuntogram for investigation of previously placed shunt e.g. ventriculoperitoneal Reprogramming of programmable cerebrospinal shunt PHYSICIAN CODING AND REIMBURSEMENT Procedure CPT Description 62160 Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage 62161 Neuroendoscopy, intracranial; with dissection of adhesions, fenestration of septum pellucidum or intraventricular cysts (including placement, replacement, or removal of ventricular catheter) 62162 Neuroendoscopy, with fenestration or excision of colloid cyst, including placement of external ventricular catheter for drainage 62163 Neuroendoscopy, with retrieval of foreign body 62164 Neuroendoscopy, with excision of brain tumor, including placement of external ventricular catheter for drainage 62165 Neuroendoscopy, with excision of pituitary tumor, transnasal or transsphenoidal approach 62200 Ventriculocisternostomy, third ventricle 62201 Ventriculocisternostomy, third ventricle; stereotactic, neuroendoscopic method +61795 Stereotactic computer assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal list separately in addition to code for primary procedure 61107 Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for implanting ventricular catheter, pressure recording device, or other intracerebral monitoring device 61210 Burr hole(s) for implanting ventricular catheter, reservoir, EEG electrode(s), pressure recording device, or other cerebral monitoring device (separate procedure) Lumbar Catheter Placement 62272 Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter) SEPS Subdural Evacuation 61108 Twist drill hole for subdural or ventricular puncture; for evacuation and/or drainage of subdural hematoma 61323 Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; with lobectomy 61322 Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy 62100 Craniotomy for repair of dural /cerebrospinal fluid leak, including surgery for rhinorrhea/otorrhea 61692 Surgery of intracranial arteriovenous malformation; dural, complex 61690 Surgery of intracranial arteriovenous malformation; dural, simple Neuroendoscopy EVD Catheter Placement Cranial Duraplasty/Dural Repair PHYSICIAN CODING AND REIMBURSEMENT Procedure Cranial Duraplasty/ Dural Repair CPT 61608 Resection or excision of neoplastic, vascular or infectious lesion of parasellar area, cavernous sinus, clivus or midline skull base; intradural, including dural repair, with or without graft 61606 Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex; intradural, including dural repair, with or without graft 61601 Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; intradural, including dural repair, with or without graft 63710 Dural graft, spinal 63709 Repair of dural /cerebrospinal fluid leak or pseudomeningocele, with laminectomy 63707 Repair of dural /cerebrospinal fluid leak, not requiring laminectomy 63182 Laminectomy and section of dentate ligaments, with or without dural graft, cervical; more than two segments 63180 Laminectomy and section of dentate ligaments, with or without dural graft, cervical; one or two segments 61616 Resection or excision of neoplastic, vascular or infectious lesion of base of posterior cranial fossa, jugular foramen, foramen magnum, or C1-C3 vertebral bodies; intradural, including dural repair, with or without graft 61343 Craniectomy, suboccipital with cervical laminectomy for decompression of medulla and spinal cord, with or without dural graft (e.g., Arnold Chiari malformation) 62143 Replacement of bone flap or prosthetic plate of skull Spinal Dural Repair Cranial Flap Repair/ Mesh Implant CT Scans MRI Spinal Puncture Description 70450-26* CT, head or brain, without contrast 70460-26* CT, head or brain, with contrast 70470-26* CT, head or brain, without and with contrast 70551-26* MRI, brain, without contrast 70552-26* MRI, brain, with contrast 70553-26* MRI, brain, without and with contrast 62270 Spinal puncture, lumbar, diagnostic 62272 Spinal puncture, tx, for drainage of CSF *NOTE: M odifier –26 is appended to some codes to indicate that hospital-owned equipment was used so the physician is being reimbursed only for the professional service of interpreting the results. Diagnosis Coding ICD-9-CM has codes for hydrocephalus, depending on its cause. 331.3 Communicating hydrocephalus 331.4Obstructive hydrocephalus 331.5Idiopathic normal pressure hydrocephalus Code 331.3 is used when hydrocephalus is secondary to another disease process such as meningitis or subarachnoid hemorrhage. Code 331.5 is the default code for NPH. When a patient is seen for issues related to shunt function, other codes are used as the principal diagnosis and hydrocephalus is coded as a secondary diagnosis. 996.2 Mechanical complications of nervous system device, implant, and graft 996.63 Infection and inflammatory reaction due to nervous system device, implant, and graft 996.75 Other complications due to nervous system device, implant, and graft V53.09 Fitting and adjustment of other devices related to nervous system Code V53.09 is used for routine programming encounters and routine replacement of shunt components. HOSPITAL INPATIENT CODING AND REIMBURSEMENT Procedure Ventricular Shunt Revision, Removal, Irrigation of Ventricular Shunt Spinal Subarachnoid Shunt ICD-9-CM Description 02.21 Insertion or replacement of external ventricular drain (EVD), is used for procedures such as an EVD set-up, placement of a ventricular catheter for drainage or sampling of cerebrospinal fluid, or for an injection of medication or other substance. 02.22 Intracranial ventricular shunt or anastomosis, includes procedures such as an insertion of a Holter valve into the intracranial system, a shunt between two intracranial ventricles, and ventriculocisternostomy. 02.31 Ventricular shunt to structure in head or neck 02.32 Ventricular shunt to circulatory system 02.33 Ventricular shunt to thoracic cavity 02.34 Ventricular shunt to abdominal cavity and organs 02.35 Ventricular shunt to urinary system 02.39 Ventricular shunt to extracranial site NEC 02.41 Irrigation and exploration of ventricular shunt 02.42 Replacement of ventricular shunt (including replacement of valve and/or catheter) 02.43 Removal of ventricular shunt 54.95 Incision of peritoneum (used for revision of the distal end of a ventriculo-peritoneal shunt) 03.71 Spinal subarachnoid-peritoneal shunt 03.72 Spinal subarachnoid-ureteral shunt 03.79 Other shunt of spinal theca HOSPITAL INPATIENT CODING AND REIMBURSEMENT Procedure Spinal Puncture Ventriculostomy Procedure EVD Catheter Placement Lumbar Drainage Procedure Subdural Hematoma Evacuation Cranial Defect Repair Procedure Creation of Shunt ICD-9-CM Description 03.31 Spinal tap 03.39 Other diagnostic procedures on spinal cord and spinal canal structures 01.26 Insertion of the catheter into a cranial cavity 02.20 Ventriculostomy for ventricular drainage 03.99 Spinal Tap for lumbar drainage 432.1 Subdural hemorrhage [subdural hematoma, non traumatic] 438.19 Diseases of the Musculoskeletal System and Connective Tissue (Other Specified Deformity) DRG Description 031 Ventricular shunt procedures WMCC 032 Ventricular shunt procedures WCC 033 Ventricular shunt procedures WO CC/MCC If code 03.39 is used with a principal diagnosis NPH, the following surgical DRGs are assigned: Extended Lumbar Drainage 028 Spinal procedures WMCC 029 Spinal procedures WCC 030 Spinal procedures WO CC/MCC If code 03.31 is used with a principal diagnosis NPH, the following medical DRGs are assigned: 056 Degenerative nervous system disorders WMCC 057 Degenerative nervous system disorders WOMCC Medtronic Neurologic Technologies 125 Cremona Drive Goleta, CA 93117-5500 USA (800) 468-9710USA/Canada (901) 344-0645International (800) 468-9713 FAX (901) 396-2698 FAX International Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service. All products should be used according to their labeling. Current Procedural Terminology (CPT) is copyright 2008 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. All rights reserved. Printed in the USA. ©2011, Medtronic, Inc. LIT59657 2012-235 1.12 Regular Spinal Tap
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