How To Use CPT Code 78645

CPT 78645 describes the imaging procedure used to evaluate the patency and function of a cerebrospinal fluid (CSF) shunt system. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 78645?

CPT 78645 can be used to describe the imaging procedure performed to evaluate the flow of cerebrospinal fluid (CSF) in a shunt system. This code is used when a provider uses nuclear diagnostic imaging to check the function and patency of a CSF shunt, which diverts CSF to an alternative site of absorption to prevent excess fluid buildup in the brain.

2. Official Description

The official description of CPT code 78645 is: ‘Cerebrospinal fluid flow, imaging (not including introduction of material); shunt evaluation.’

3. Procedure

1. During the procedure, the provider uses nuclear diagnostic imaging to assess the flow of cerebrospinal fluid (CSF) in a shunt system.
2. The patient is positioned in a supine position, and a radiopharmaceutical substance is injected into the shunt appliance, which includes a valve, reservoir, and catheter.
3. The provider uses a scintillation or gamma camera to detect the gamma rays emitted by the radioactive substance.
4. Multiple images are taken of the head, chest, and catheter termination point to track the movement of the radioactive substance from the shunt in the brain to the distal end.
5. The provider evaluates the obtained images to ensure that the CSF shunt is functioning properly.

4. Qualifying circumstances

CPT 78645 is used when a patient has a CSF shunt system in place and there is a need to evaluate its function and patency. This procedure is typically performed on patients with obstructed CSF flow who have undergone CSF shunt placement. The provider uses nuclear diagnostic imaging to assess the flow of CSF through the shunt system and ensure that it is functioning properly.

5. When to use CPT code 78645

CPT code 78645 should be used when a provider performs an imaging procedure to evaluate the function and patency of a CSF shunt system. This code is appropriate when the provider uses nuclear diagnostic imaging to assess the flow of CSF through the shunt and ensure that it is functioning properly. It should not be used for the introduction of material into the shunt system.

6. Documentation requirements

To support a claim for CPT 78645, the provider must document the following information:

• Indication for the evaluation of the CSF shunt system
• Details of the imaging procedure performed
• Images obtained during the procedure
• Evaluation of the CSF shunt system’s function and patency
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 78645, ensure that the procedure involves the evaluation of a CSF shunt system using imaging. Use the appropriate CPT codes (61000-61070, 62270-62294) to report the injection portion of the procedure if necessary. If reporting only the physician’s interpretation for the radiology service, append modifier 26. If reporting only the technical component, append modifier TC. However, be aware that payer policies may exempt hospitals from appending modifier TC. Do not append professional or technical modifiers when reporting a global service where one provider renders both components.

8. Historical information

CPT 78645 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A provider performs an imaging procedure to evaluate the function and patency of a CSF shunt system in a patient with hydrocephalus.
2. During the procedure, the provider uses nuclear diagnostic imaging to assess the flow of CSF through the shunt and ensure that it is functioning properly.
3. Images obtained during the procedure show that the CSF is flowing appropriately through the shunt system, indicating that it is functioning as intended.
4. The provider documents the evaluation of the CSF shunt system and signs off on the procedure.
5. Another provider performs an imaging procedure to evaluate the function and patency of a CSF shunt system in a patient with a history of meningitis.
6. Using nuclear diagnostic imaging, the provider assesses the flow of CSF through the shunt and confirms that it is functioning properly.
7. The obtained images show no signs of obstruction or malfunction in the CSF shunt system.
8. The provider documents the evaluation and signs off on the procedure, ensuring accurate billing and documentation.
9. A different provider performs an imaging procedure to evaluate the function and patency of a CSF shunt system in a pediatric patient with congenital hydrocephalus.
10. Using nuclear diagnostic imaging, the provider carefully assesses the flow of CSF through the shunt and confirms that it is functioning as expected.