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An open ventriculocisternostomy is a neurosurgical procedure aimed at establishing a direct communication between the third ventricle of the brain and the subarachnoid space, specifically the cistern. This procedure is typically indicated for conditions that lead to obstructive hydrocephalus, where cerebrospinal fluid (CSF) cannot flow freely due to blockages. The surgery begins with a circular incision in the scalp, usually located in the right frontal area, allowing for the creation of a skin flap that is moved forward to expose the underlying structures. Following this, a craniotomy is performed, which involves removing a portion of the skull to access the brain. The dura mater, a protective membrane covering the brain, is then opened to reveal the lateral ventricle. A catheter is inserted into the lateral ventricle to measure intracranial pressures, which are critical for assessing the patient's condition. The catheter is subsequently advanced into the third ventricle, where a puncture is made in the floor to facilitate the creation of an opening that connects the third ventricle to the subarachnoid cistern. This opening is carefully enlarged to ensure adequate flow of CSF. In cases where CSF flow is insufficient, further exploration of the prepontine cistern may be conducted to identify and address any arachnoid bands that may be obstructing the flow. If an imperforate membrane of Liliequist is discovered, it is disrupted to enhance CSF drainage. Should the initial attempts not yield satisfactory results, a second communication may be established. Once a successful communication is confirmed, closing intracranial pressures are measured, and if they are found to be elevated, an external ventricular drain may be placed to manage the CSF flow effectively.
© Copyright 2025 Coding Ahead. All rights reserved.
The open ventriculocisternostomy procedure is indicated for specific medical conditions that necessitate the alleviation of obstructive hydrocephalus. The following are the primary indications for performing this procedure:
The open ventriculocisternostomy procedure involves several critical steps to ensure successful communication between the third ventricle and the subarachnoid space. The following outlines the procedural steps:
Post-procedure care following an open ventriculocisternostomy involves monitoring the patient for any signs of complications, such as infection or continued elevated intracranial pressure. Patients are typically observed in a hospital setting where their neurological status and CSF drainage are closely monitored. The placement of an external ventricular drain, if necessary, allows for the management of CSF flow and helps prevent further complications. Recovery may vary depending on the individual patient's condition and the complexity of the procedure, but ongoing assessments are crucial to ensure proper healing and function.
| Short Descr | ESTABLISH BRAIN CAVITY SHUNT | Medium Descr | VENTRICULOCISTERNOSTOMY 3RD VENTRICLE | Long Descr | Ventriculocisternostomy, third ventricle; | Status Code | Active Code | Global Days | 090 - Major Surgery | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 2 - Insertion, replacement, or removal of extracranial ventricular shunt |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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 | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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