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A ventricular puncture is a medical procedure that involves accessing the ventricles of the brain, which are fluid-filled cavities, through a previously established entry point such as a burr hole, fontanelle, suture, or an implanted ventricular catheter or reservoir. This procedure is typically performed to either diagnose or treat various neurological conditions. The process begins with preparing the scalp, which may involve cutting hair or shaving the area over the intended puncture site to ensure a sterile environment. When accessing the ventricles through a burr hole, fontanelle, or suture, a spinal needle is carefully advanced through the skin and into the ventricle. The stylet of the needle is then removed to allow cerebrospinal fluid (CSF) and blood to be drained, which can help relieve pressure within the cranial cavity. After the necessary fluid is withdrawn, the stylet is replaced, the needle is removed, and a dressing is applied to the puncture site to promote healing and prevent infection. In cases where the puncture is made through an implanted ventricular catheter or reservoir, the needle is inserted at a specific angle (30 to 45 degrees) into the reservoir bladder. Similar to the previous method, CSF and blood are drained, and as the intracranial pressure decreases, the flow rate of the fluid will slow down. Once the pressure has been adequately reduced, the needle is withdrawn, and firm pressure is applied to the site to ensure that drainage has ceased. This procedure can also involve the injection of medication or other substances, such as gas, contrast media, dye, or radioactive material, into the ventricle simultaneously with the withdrawal of CSF. The head may be rotated to help disperse the injected substance throughout the ventricular system. If the injection is performed for the purpose of ventriculography, any necessary radiographs must be reported separately. This comprehensive approach allows for both diagnostic and therapeutic interventions in managing conditions affecting the brain's ventricular system.
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The ventricular puncture procedure is indicated for various diagnostic and therapeutic purposes. The following conditions may warrant the performance of this procedure:
The ventricular puncture procedure involves several critical steps to ensure proper execution and patient safety. The following outlines the procedural steps:
After the ventricular puncture procedure, several post-procedure care steps are essential for patient recovery and safety. The puncture site should be monitored for signs of infection, bleeding, or other complications. Firm pressure is applied to the puncture site until drainage has stopped to minimize the risk of hematoma formation. Patients may be observed for changes in neurological status, as any alterations could indicate complications related to the procedure. Additionally, instructions regarding activity restrictions and follow-up appointments should be provided to the patient to ensure proper healing and management of any underlying conditions. If imaging studies, such as radiographs, are required following the injection for ventriculography, these should be scheduled and performed as indicated. Overall, careful monitoring and follow-up care are critical components of the post-procedure process to ensure optimal patient outcomes.
| Short Descr | INJECTION INTO BRAIN CANAL | Medium Descr | VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ | Long Descr | Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; with injection of medication or other substance for diagnosis or treatment | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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.) | AG | Primary physician | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
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| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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