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A ventricular puncture is a medical procedure that involves accessing the ventricles of the brain through a previously established entry point, such as a burr hole, fontanelle, suture, or an implanted ventricular catheter or reservoir. This specific procedure, identified by CPT® Code 61020, is performed without the injection of any substances. The process begins with the preparation of the scalp, which may involve cutting hair or shaving the area over the intended puncture site to ensure a sterile environment. If the puncture is made through a previous burr hole, fontanelle, or suture, a spinal needle is carefully advanced through the skin and into the ventricle. Once the needle is in place, the stylet is removed to allow for the drainage of cerebrospinal fluid (CSF) and any blood present. After the desired amount of fluid is drained, the stylet is reinserted, the needle is withdrawn, and a dressing is applied to the puncture site to promote healing and prevent infection. In cases where the puncture is performed through an implanted ventricular catheter or reservoir, the needle is inserted at a specific angle (30 to 45 degrees) into the reservoir bladder, allowing for the drainage of CSF and blood. As the intracranial pressure decreases, the flow rate of the fluid will slow down. Once sufficient pressure reduction is achieved, the needle is removed, and firm pressure is applied to the puncture site until the drainage has completely stopped. It is important to note that if the procedure involves the injection of medication or other substances, CPT® Code 61026 should be used instead, which includes additional steps for the instillation of substances for diagnostic or therapeutic purposes.
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The ventricular puncture procedure is indicated for various clinical scenarios where access to the cerebrospinal fluid (CSF) is necessary. The following conditions may warrant this procedure:
The procedure for ventricular puncture is carried out in a systematic manner to ensure safety and efficacy. The following steps outline the process:
After the ventricular puncture procedure, it is essential to monitor the patient for any signs of complications, such as infection or bleeding at the puncture site. The patient may be observed for changes in neurological status, and follow-up imaging may be required to assess the effectiveness of the procedure. Proper care of the puncture site, including keeping it clean and dry, is crucial for preventing infection. Patients should be advised on any activity restrictions and signs of complications that warrant immediate medical attention.
| Short Descr | REMOVE BRAIN CAVITY FLUID | Medium Descr | VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX | Long Descr | Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; without injection | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 2 | CCS Clinical Classification | 1 - Incision and excision of CNS |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| Pre-1990 | Added | Code added. |
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