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Cerebrospinal fluid (CSF) flow imaging is a diagnostic procedure that utilizes scintigraphy along with a radiolabeled isotope tracer to visualize the movement of CSF within the central nervous system. This imaging technique is essential for identifying abnormalities in CSF flow, which can include conditions such as communicating and non-communicating hydrocephalus, as well as fistulas that may connect a CSF reservoir, or cistern, to the nasal cavity or ear. The CSF is produced in the lateral ventricles of the brain and flows through various structures, including the foramen of Monro into the third ventricle, and subsequently into the fourth ventricle via the aqueduct of Sylvius. A small volume of CSF is also generated in the spinal canal, which merges with the intraventricular CSF supply in the fourth ventricle. From there, it circulates into the subarachnoid spaces through the medial foramen of Magendie and the lateral foramina of Luschka. The movement of CSF is driven by bulk flow, which occurs from areas of high pressure to those of lower pressure, as well as by pulsatile motion that is influenced by the cardiac cycle of the cerebral arteries. During the procedure, a radiolabeled isotope tracer is introduced into the CSF through a lumbar puncture. The patient is then positioned on an imaging table, with a gamma camera placed over the area of interest. Scanning is conducted at predetermined intervals, capturing the radioactive energy emitted from the tracer, which is then transformed into a visual image for analysis. It is important to note that CPT® Code 78630 is designated for studies focusing on the cisterns (cisternography), while CPT® Code 78635 is specifically used for studies concentrating on the ventricles (ventriculography). Following the imaging, the physician interprets the results and generates a comprehensive written report detailing the findings.
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The cerebrospinal fluid flow imaging procedure is indicated for the evaluation of various conditions related to abnormal CSF dynamics. The following are the specific indications for performing this imaging study:
The procedure for cerebrospinal fluid flow imaging involves several critical steps to ensure accurate results. The following outlines the detailed procedural steps:
After the cerebrospinal fluid flow imaging procedure, the patient may be monitored for any immediate complications related to the lumbar puncture, such as headache or discomfort at the injection site. It is essential to provide post-procedure care instructions, which may include recommendations for hydration and rest. The physician will review the imaging results and discuss the findings with the patient, outlining any necessary follow-up actions or additional diagnostic steps based on the outcomes of the study.
| Short Descr | CSF VENTRICULOGRAPHY | Medium Descr | CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY | Long Descr | Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography | 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) | 0 - No 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) | 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 | Procedure or Service, Not Discounted when Multiple | ASC Payment Indicator | Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | I1E - Standard imaging - nuclear medicine | MUE | 1 | CCS Clinical Classification | 209 - Radioisotope scan and function studies |
| 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. | 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 |
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| Pre-1990 | Added | Code added. |
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