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Official Description

Removal of complete cerebrospinal fluid shunt system; with replacement by similar or other shunt at same operation

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 62258 involves the removal of a complete cerebrospinal fluid (CSF) shunt system, which is a medical device used to manage conditions related to CSF flow, such as hydrocephalus. This code specifically refers to the removal of the existing shunt system and the simultaneous replacement with a similar or different shunt during the same surgical operation. The need for such a procedure may arise due to complications associated with the original shunt, such as obstruction or infection, or if the shunt was intended for temporary use. The process entails a meticulous surgical approach where the shunt valve and both proximal and distal catheters are carefully detached and removed. Following this, a new shunt system is inserted, ensuring that it is properly connected and functioning to facilitate the flow of cerebrospinal fluid. This procedure is critical for maintaining proper CSF dynamics and preventing further complications related to CSF accumulation or drainage issues.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 62258 is indicated for patients who require the removal and replacement of a cerebrospinal fluid shunt system due to various complications or specific clinical scenarios. These indications may include:

  • Obstruction: The shunt may be obstructed, preventing proper drainage of cerebrospinal fluid.
  • Infection: The presence of infection in the shunt system necessitates removal and replacement to prevent further complications.
  • Temporary Use: The shunt may have been placed temporarily, requiring removal and replacement with a more permanent solution.

2. Procedure

The procedure for CPT® Code 62258 involves several detailed steps to ensure the safe removal of the existing shunt system and the installation of a new one. Each step is critical for the success of the operation:

  • Step 1: The surgical team begins by exposing the shunt valve, which is the central component of the shunt system. The proximal and distal catheters are then detached from the shunt valve, allowing for the removal of the valve itself.
  • Step 2: Following the removal of the shunt valve, the proximal catheter is addressed. A skin incision is made over the shunt site, and the surrounding soft tissues are carefully dissected. Any sutures anchoring the catheter are cut, and a guidewire is advanced through the catheter to facilitate its removal. The catheter is then extracted over the guidewire, and a temporary drain may be placed if necessary.
  • Step 3: The distal catheter is similarly removed. A guidewire is placed, and the subcutaneous tunnel is opened to free the shunt from its tunnel. The terminal end of the distal catheter is then removed.
  • Step 4: After the existing shunt system is completely removed, a new proximal catheter is inserted into the appropriate anatomical space, such as the ventricle, subarachnoid, or subdural space. This new catheter is then connected to a new shunt valve.
  • Step 5: The new shunt valve is tested to ensure proper cerebrospinal fluid flow. If functioning correctly, the distal catheter is advanced into the termination site, which may involve rerouting to a new location if necessary.
  • Step 6: If the distal catheter is to terminate in the jugular vein, right atrium, or atrial appendage, a cannula is placed under the scalp and advanced through the subgaleal space and neck muscles. The catheter is then advanced into the jugular vein or further into the right atrium.
  • Step 7: In cases where the shunt terminates in the peritoneum or pleural cavity, a second incision is made in the chest or abdomen to expose the respective cavity. The cannula is advanced appropriately, and the distal end of the catheter is positioned in the designated area.

3. Post-Procedure

Post-procedure care following the removal and replacement of a cerebrospinal fluid shunt system is crucial for patient recovery and monitoring. Patients are typically observed for any signs of complications, such as infection or improper shunt function. Follow-up imaging may be required to ensure that the new shunt system is functioning correctly and that cerebrospinal fluid is being adequately drained. Patients may also need to be monitored for any neurological changes or symptoms that could indicate issues with the new shunt. Proper documentation of the procedure and any post-operative instructions is essential for ongoing patient care.

Short Descr REPLACE BRAIN CAVITY SHUNT
Medium Descr RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT
Long Descr Removal of complete cerebrospinal fluid shunt system; with replacement by similar or other shunt at same operation
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

This is a primary code that can be used with these additional add-on codes.

62160 Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure)
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).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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.
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.)
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).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code 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
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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2002-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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