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Official Description

Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 75809 refers to a specialized radiological procedure known as a shuntogram, which is performed to evaluate the functionality and patency of previously placed indwelling non-vascular shunts. These shunts may include devices such as the LeVeen shunt, ventriculoperitoneal (VP) shunt, or indwelling infusion pumps. The procedure utilizes radiopaque contrast medium and fluoroscopy to visualize the shunt system, allowing healthcare professionals to assess for potential issues such as dislodgement, malfunction, or obstruction. The VP shunt specifically facilitates the drainage of cerebrospinal fluid (CSF) from the brain's ventricles to the abdominal cavity, which is crucial for managing conditions that involve excess CSF. During the shuntogram, initial scout films are taken to locate the radiopaque catheter, followed by a series of steps that involve the removal of CSF, injection of contrast medium, and obtaining serial images to monitor the flow and function of the shunt. This comprehensive evaluation is essential for ensuring the proper functioning of the shunt system and for guiding further medical interventions if necessary.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The shuntogram procedure is indicated for the following conditions:

  • Evaluation of Shunt Patency The procedure is performed to assess whether the previously placed indwelling non-vascular shunt is functioning properly and is not obstructed.
  • Assessment of Shunt Malfunction It is utilized to investigate any potential malfunctions in the shunt system that may affect its performance.
  • Investigation of Shunt Dislodgement The shuntogram helps determine if the shunt has become dislodged from its intended position, which could lead to complications.

2. Procedure

The shuntogram procedure involves several detailed steps to ensure accurate evaluation of the shunt system:

  • Step 1: Initial Imaging Scout films are obtained of the cranium, chest, and abdomen to identify the location of the radiopaque catheter associated with the shunt. This initial imaging is crucial for guiding the subsequent steps of the procedure.
  • Step 2: Preparation of the Shunt Site The scalp is shaved over the area of the shunt valve, and the skin is prepped and draped to maintain a sterile environment. This preparation is essential to minimize the risk of infection during the procedure.
  • Step 3: CSF Removal A small gauge butterfly needle is used to enter the shunt valve, and 1-2 ml of cerebrospinal fluid (CSF) is removed. This step is important for clearing the valve and allowing for the effective injection of contrast medium.
  • Step 4: Injection of Contrast Medium After CSF removal, radiopaque contrast medium is injected into the shunt system. This contrast medium is vital for visualizing the flow of fluid through the shunt during imaging.
  • Step 5: Serial Imaging Serial films are obtained from the cranium to the abdomen to monitor the flow of contrast medium through the shunt system. This imaging helps identify any obstructions or malfunctions in the shunt.
  • Step 6: Final Imaging and Valve Pumping At the conclusion of the study, the shunt valve is pumped to clear the system, and final films are obtained to document the findings and ensure that the shunt is functioning correctly.
  • Step 7: Additional Procedures for Peritoneovenous Shunt If a peritoneovenous shunt is being evaluated, scout films of the chest and abdomen are obtained, and contrast medium may be injected into the peritoneal fluid. Serial films are then taken to monitor the flow of fluid from the abdomen into the venous system and lungs. If a blood clot is suspected, contrast medium may be injected simultaneously in both arms, followed by serial imaging to rule out clots.
  • Step 8: Indwelling Infusion Pump Evaluation For an indwelling infusion pump, the pump reservoir is located, and a needle is inserted into the refill port. Contrast medium is injected, and serial films are obtained to document the flow from the reservoir to the target area for medication delivery.

3. Post-Procedure

After the shuntogram procedure, the healthcare provider will review the obtained images and interpret the findings. A written report detailing the results of the evaluation will be generated. Patients may be monitored for any immediate post-procedural complications, and further management will be determined based on the findings of the shuntogram. It is essential to ensure that the shunt system is functioning properly to prevent any potential complications related to shunt malfunction or obstruction.

Short Descr NONVASCULAR SHUNT X-RAY
Medium Descr SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I
Long Descr Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation
Status Code Active Code
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51) 6 - Special payment adjustment rules on the technical component (TC) of multiple diagnostic cardiovascular services 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) 0 - 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 T-Packaged Codes
ASC Payment Indicator Packaged service/item; no separate payment made.
Type of Service (TOS) 4 - Diagnostic Radiology
Berenson-Eggers TOS (BETOS) I1F - Standard imaging - other
MUE 1
CCS Clinical Classification 226 - Other diagnostic radiology and related techniques
26 Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
TC Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles
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).
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).
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.
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.
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.)
CR Catastrophe/disaster related
FY X-ray taken using computed radiography technology/cassette-based imaging
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
N1 Group 1 oxygen coverage criteria met
X2 Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2011-01-01 Changed Short description changed.
2001-01-01 Changed Code description changed.
1993-01-01 Added First appearance in code book in 1993.
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