How To Use CPT Code 62223

CPT 62223 describes the creation of a shunt, which is a tube used to drain excess cerebrospinal fluid (CSF) from the ventricles of the brain to another location in the body. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 62223?

CPT 62223 is used to describe the creation of a shunt, specifically a ventriculo-peritoneal, -pleural, or other terminus shunt. This procedure involves placing a tube from the ventricles of the brain to another location in the body, such as the abdominal or pleural cavity, to drain excess cerebrospinal fluid. It is commonly performed to treat conditions like hydrocephalus, where the ventricles enlarge with CSF and create pressure on the brain.

2. Official Description

The official description of CPT code 62223 is: ‘Creation of shunt; ventriculo-peritoneal, -pleural, other terminus.’

3. Procedure

1. The provider begins by making an incision in the scalp and pulling it back to expose the skull.
2. A burr hole is then drilled into the skull, specifically into the dura mater, which is the protective covering of the brain.
3. The provider may use a neuroendoscope, a small tubular instrument with a fiberoptic light source, to assist with the placement of the shunt.
4. Using either freehand technique or with the aid of the neuroendoscope, the provider incises the underlying cortex and inserts the shunt into the ventricles of the brain to drain excess CSF.
5. The opposite end of the shunt is placed in the chosen drainage site, which may involve subcutaneously tunneling the tube to the abdominal or pleural cavity, or another appropriate location in the body.
6. The provider may need to suture the shunt into place to ensure proper positioning and stability.
7. Once the procedure is complete, the provider obtains hemostasis, removes all instrumentation, and closes the scalp in layers, covering the wounds with sterile dressings.

4. Qualifying circumstances

CPT 62223 is performed for patients with conditions that require the drainage of excess cerebrospinal fluid, such as hydrocephalus. The procedure is typically carried out by a qualified healthcare professional and may involve the use of a neuroendoscope. The shunt is placed from the ventricles of the brain to another location in the body, such as the abdominal or pleural cavity, to allow for proper drainage and relieve pressure on the brain.

5. When to use CPT code 62223

CPT code 62223 should be used when a provider performs the creation of a shunt, specifically a ventriculo-peritoneal, -pleural, or other terminus shunt. This code is appropriate for cases where excess cerebrospinal fluid needs to be drained from the ventricles of the brain to another location in the body. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT 62223, the provider must document the following information:

• Patient’s diagnosis necessitating the creation of the shunt
• Specific type of shunt created (ventriculo-peritoneal, -pleural, or other terminus)
• Details of the procedure, including the use of a neuroendoscope if applicable
• Location of the drainage site and any subcutaneous tunneling performed
• Confirmation of proper shunt placement and stability
• Steps taken to achieve hemostasis and closure of the surgical site

7. Billing guidelines

When billing for CPT 62223, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The provider should also consider any additional guidelines provided by payers or coding authorities. It is important to note that if a neuroendoscope is used during the procedure, it should be reported separately using the appropriate code for neuroendoscopy.

8. Historical information

CPT 62223 was added to the Current Procedural Terminology system on January 1, 1990. In 2017, it was added to the Inpatient Only (IPO) list for Medicare billing purposes.

9. Examples

1. A neurosurgeon performs the creation of a ventriculo-peritoneal shunt to drain excess cerebrospinal fluid in a patient with hydrocephalus.
2. A pediatric neurologist places a ventriculo-pleural shunt to relieve pressure on the brain in a child with a congenital condition.
3. An adult patient with a history of traumatic brain injury undergoes the creation of a ventriculo-peritoneal shunt to manage the accumulation of cerebrospinal fluid.
4. A neurosurgeon performs the creation of an alternative terminus shunt to drain excess cerebrospinal fluid in a patient with a rare neurological disorder.
5. A neurologist places a ventriculo-pleural shunt to alleviate symptoms in a patient with normal pressure hydrocephalus.
6. A neurosurgeon performs the creation of a ventriculo-peritoneal shunt to manage the drainage of cerebrospinal fluid in a patient with a brain tumor.
7. A pediatric neurologist places an alternative terminus shunt to drain excess cerebrospinal fluid in an infant with congenital hydrocephalus.