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The CPT® Code 63741 refers to the creation of a shunt in the lumbar region, specifically a subarachnoid-peritoneal, subarachnoid-pleural, or other types of shunts, performed percutaneously without the need for a laminectomy. This procedure is primarily indicated for the treatment of communicating hydrocephalus, a condition characterized by an accumulation of cerebrospinal fluid (CSF) in the brain's ventricles, which can lead to increased intracranial pressure and various neurological symptoms. The shunt allows for the diversion of CSF from the subarachnoid space to alternative locations such as the peritoneal cavity or pleural cavity, thereby alleviating pressure and preventing further complications. Unlike the procedure described in CPT® Code 63740, which involves a laminectomy to expose the spinal cord, the approach for CPT® Code 63741 is less invasive, utilizing a percutaneous technique that minimizes tissue disruption and recovery time. This method involves the insertion of a spinal needle into the lumbar region, allowing for the placement of a catheter directly into the subarachnoid space, facilitating the drainage of CSF to the designated area without the need for extensive surgical intervention.
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Communicating Hydrocephalus The primary indication for the creation of a lumbar subarachnoid shunt is the treatment of communicating hydrocephalus, where there is an abnormal accumulation of cerebrospinal fluid (CSF) within the brain's ventricles, leading to increased intracranial pressure and potential neurological deficits.
Step 1: Preparation The procedure begins with the patient being positioned appropriately, and the skin over the planned puncture site is thoroughly cleansed to reduce the risk of infection. This preparation is crucial for maintaining a sterile environment during the procedure.
Step 2: Needle Insertion A spinal needle with a Huber tip is then carefully inserted through the selected intervertebral space and advanced into the spinal canal. This step is performed under separately reportable imaging guidance to ensure accurate placement of the needle within the spinal canal.
Step 3: Meningeal Puncture Once the needle is correctly positioned, the meninges are punctured, allowing access to the subarachnoid space. This step is critical as it enables the subsequent placement of the catheter for CSF drainage.
Step 4: Catheter Placement A catheter is then passed through the spinal needle into the subarachnoid space. This catheter serves as the conduit for draining CSF from the spinal canal to the designated termination site.
Step 5: Terminal Catheter Placement Utilizing a catheter passer and trocar, the terminal end of the catheter is advanced into the pleural or peritoneal space, or another specified termination site. This step completes the shunting process, allowing for the effective diversion of CSF to alleviate pressure in the central nervous system.
After the procedure, the patient is typically monitored for any immediate complications, such as infection or bleeding at the puncture site. Follow-up care may include imaging studies to ensure proper placement of the shunt and to assess the effectiveness of CSF drainage. Patients may also receive instructions regarding activity restrictions and signs of potential complications that should prompt immediate medical attention. The recovery period is generally shorter compared to more invasive procedures, allowing for a quicker return to normal activities.
| Short Descr | INSTALL SPINAL SHUNT | Medium Descr | CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ X LAM | Long Descr | Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; percutaneous, not requiring laminectomy | 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 | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system procedures |
| 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). | 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). | 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 | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 1991-01-01 | Added | First appearance in code book in 1991. |
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