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Code This!

Scenario Week of September 26, 2011:
View Current Scenario

Outpatient Surgery setting

Op report: Shunt tap
Adjustment of Medtronic Strata Valve

Diagnosis: Suspected ventriculoperitoneal shunt malfunction
Hydrocephalus

Procedure Findings: Satisfactory proximal outflow was noted from the shunt valve with opening pressure questionably approximately 12-15. The CSF was grossly clear in appearance. Runoff appeared satisfactory, although the patient evidently had a pediatric valve placed which was difficult to definitively occlude. Therefore, it is difficult to ascertain the status of distal runoff. After completion of the shunt tap, the patient’s Strata shunt valve was checked. The pressure appeared to be level 0.5. The prior operative note had reported a setting of 1.5 and has been readjusted to 1.5, although we elected to proceed at this point acutely with shunt exploration and revision.

Description of Procedure: After obtaining proper patient identification and appropriate preprocedure informed consent, the patient was positioned in a lateral decubitus partially-prone position with right posterior region of his head uppermost to optimize access to the shunt valve. The patient’s right parieto-occipital region was cleansed with alcohol, and the patient was the prepped with Betadine solution and sterilely draped in the usual fashion. The shunt valve was accessed with a questionably 23-gauge Angiocath with satisfactory CSF egress noted. The Angiocath was connected to a manometer with findings as noted above.

The CSF was sent as specimen for routine analysis as noted. The Angiocath was withdrawn, and hemostasis was achieved at the puncture site. Antibiotic ointment and sterile dressing were applied. Subsequently, the Medtronic valve programming unit was employed to assess the current valve setting with findings as noted above. The programmer magnet was then applied, and the valve was reset to 1.5 as noted and appropriate setting confirmed. The patient tolerated this procedure well and remained in stable condition.

Please assign the correct CPT and ICD-9-CM diagnosis and procedure codes.


ANSWERS:
CPT Codes
61070 Puncture of shunt tubing or reservoir for aspiration or injection procedure
62252 Reprogramming of programmable cerebrospinal shunt

ICD-9-CM Diagnosis Codes
V53.01 Fitting and adjustment of cerebral ventricular (communicating) shunt
331.4 Obstructive hydrocephalus

ICD-9-CM Procedure Codes
01.02 Ventriculopuncture through previously implanted catheter
02.41 Irrigation and exploration of ventricular shunt

Rationale
Codes 61070 and 01.02 should be reported for the shunt tap in which small amounts of fluid are aspirated to check for adequate drainage. Report CPT code 62252 for the reprogramming of the shunt. The ICD-9-CM procedure code is a little more difficult to find because the term “reprogramming” is not in the index. It is found in the tabular section under code 02.41 as an includes note reading, “Re-programming of ventriculoperitoneal shunt.”

The first-listed diagnosis code should be V53.01 because the malfunction of the shunt valve was not proven. Therefore, per the Official ICD-9-CM Guidelines section IV.O., the final diagnosis should be the postoperative diagnosis, which in this case is not malfunction, only reprogramming. Code 331.4 should be reported as this is the reason the patient has the VP shunt.
 
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