A patient with congenital hydrocephalus status post ventriculoperitoneal (VP) shunt was admitted due to shunt failure. The VP shunt had become free of its connection and had migrated into the abdomen. Surgery was performed to replace the migrated portion of the VP shunt. The distal end of the catheter was removed laparoscopically from the abdomen and replaced. An incision was then made in the periauricular area to expose the site of the distal tubing, and cerebrospinal fluid was seen flowing through the disconnected tubing. A tunneler was used, and the distal tubing was brought back to the periauricular incision and tied to the connecter. Please clarify the correct ICD-10-PCS procedure code(s) for laparoscopic retrieval of VP shunt with replacement of the distal catheter. Should the shunt be classified as a drainage device?
A ventriculoperitoneal (VP) shunt is not classified as a drainage device. The shunt was initially placed to reroute the contents of the cerebral ventricle to another location, and “Bypass” is the appropriate root operation for the initial VP shunt procedure. In ICD-10-PCS, “Drainage” is defined as taking/letting out fluids/gases, whereas “Bypass” is defined as altering the route of passage of the contents of a tubular body part.
The device value is “synthetic substitute” because the original root operation for placing the VP shunt is “Bypass,” and the device placed in that root operation and now being revised is classified as a synthetic substitute. The sites of the procedures to revise the shunt are the peritoneal cavity and the subcutaneous tissue of the periauricular area (behind the ear), respectively. Assign the following ICD-10-PCS procedure codes:
0WWG4JZ Revision of synthetic substitute in peritoneal cavity, percutaneous endoscopic approach
0JWS0JZ Revision of synthetic substitute in head and neck subcutaneous tissue and fascia, open approach