October 31, 2008

ACR Radiology Coding Source™ September-October 2008 Q and A

Q: A patient is not receiving adequate pain relief, and the patient’s intrathecal catheter is therefore evaluated for dislodgement, discontinuity, or kinking. Contrast is injected through the catheter with fluoroscopic guidance to identify the potential problem. What is the appropriate code(s) to report for this implanted pump catheter dye study?

A: An implanted pump catheter dye study to evaluate for shunt catheter patency or leakage is appropriately reported by codes 61070, Puncture of shunt tubing or reservoir for aspiration or injection procedure, and 75809, Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shun indwelling infusion pump), radiological supervision and interpretation. Code 61070 describes the shunt access and injection procedure itself, and code 75809 describes the supervision and interpretation of the study. A shuntogram, which requires the injection of contrast, can be reported for evaluation of a variety of similar and related nonvascular shunt catheters and devices. Occasionally, evaluation for discontinuity is performed using plain radiography or computed tomography (CT) imaging, without catheter contrast injection. In such cases, the service should be reported using the appropriate radiography or CT code that describes the anatomical area imaged (eg, brain, neck, chest, and/or abdomen).

Fluoroscopic guidance is not reported separately because it is the radiologic technique used to produce the shuntogram images, and it was included in the valuation of the shuntogram code 75809.

To report the contrast used, select the correct Healthcare Common Procedure Coding System level II code on the basis of intrathecal use and the concentration of iodine. The following codes are available for use:
Q9965 Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml
Q9966 Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml
Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml

For more details on low osmolar contrast material use, see Clinical Examples in Radiology, Volume 1, Issue 3; (Summer 2005).