Ventriculoperitoneal Shunt (VP Shunt)

CPT 62223 · 13.7 wRVU · 90-day global
CPT62223
wRVU13.7
Global90-day
ApproachOpen
ComplexityComplex
Add-on / Variant CPTs
  • 62225 wRVU: 6.04 — Replacement or irrigation of ventricular (proximal) catheter specifically (6.04 wRVU, 90-day global) — bill alongside 62230 when both ventricular and distal catheters are revised
  • 62230 wRVU: 11.14 — Replacement or revision of valve or distal (peritoneal/atrial) catheter (11.14 wRVU, 90-day global) — does NOT include ventricular catheter; use 62225 for proximal component
  • 62258 wRVU: 15.25 — Complete shunt replacement (all components; 15.25 wRVU, 90-day global) — use when entire system is replaced in one setting
  • 62220 wRVU: 13.75 — Alternative primary — ventriculoatrial shunt creation (13.75 wRVU, 90-day global)
Preoperative Diagnosis:

Hydrocephalus, [communicating / obstructive / normal pressure]

Postoperative Diagnosis:

Same

Procedure Performed:

Right ventriculoperitoneal shunt placement

Attending Surgeon:

[Attending name], MD

First Assistant:

[Resident/Fellow/PA name]

Anesthesia:

General endotracheal

Indications:

Patient presents with [communicating hydrocephalus / obstructive hydrocephalus / normal pressure hydrocephalus] with [ventriculomegaly on CT / clinical triad of dementia, gait instability, incontinence / increased ICP symptoms]. [Large-volume LP tap test positive.] Risks including shunt obstruction, infection, overdrainage, subdural hygroma, abdominal complications, and need for revision discussed. Consent obtained.

Findings:

CT head demonstrated [moderate / severe] ventricular enlargement [with transependymal edema / without]. Target for frontal horn catheter placement identified. Peritoneal cavity accessible.

Description of Procedure:

The patient was positioned supine with the head turned to the left and the right shoulder elevated. The right scalp, neck, chest, and right upper abdomen were prepped and draped in sterile fashion.

A right frontal burr hole was placed at Kocher's point (approximately 11 cm posterior to the nasion, 2.5-3 cm lateral to midline, 1 cm anterior to the coronal suture in the mid-pupillary line) using a high-speed drill. The dura was cauterized and opened sharply. A [medium pressure / programmable] [Medtronic Strata / Codman Hakim / Miethke proGAV / Sophysa Polaris] valve system was prepared and flushed with antibiotic-impregnated saline.

The ventricular catheter was passed [with / without] neuronavigation guidance toward the ipsilateral frontal horn at a depth of [6 cm]. CSF return confirmed ([clear / xanthochromic]). The catheter was secured to the valve at the burr hole.

The ventricular catheter was tunneled subcutaneously via a retroauricular relay incision to a small [right paramedian / right upper quadrant] abdominal incision. The peritoneum was entered under direct visualization. The peritoneal catheter was introduced into the peritoneal cavity and the distal end positioned in the right upper quadrant; free CSF flow from the peritoneal end confirmed; catheter secured with a purse-string suture.

All wounds were irrigated with antibiotic solution. Galea and skin closed in layers. Patient tolerated the procedure well.

Complications:

None

Specimens:

CSF for cell count, protein, glucose, culture, and [cytology]

Estimated Blood Loss:

Minimal

Drains:

VP shunt system in place

Disposition:

Patient taken to neurosurgical ICU/floor in stable condition.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Hydrocephalus, [communicating / obstructive / normal pressure]
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right ventriculoperitoneal shunt placement
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: General endotracheal

INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with [communicating / obstructive / normal pressure] hydrocephalus and ventriculomegaly on CT. [Clinical triad of dementia, gait instability, and incontinence present. Large-volume LP tap test positive.] Risks including shunt obstruction, infection, overdrainage, subdural hygroma, abdominal complications, and need for revision were discussed. Informed consent obtained.

FINDINGS: CT head demonstrated [moderate / severe] ventricular enlargement [with transependymal edema]. Target for frontal horn catheter identified at Kocher's point. Peritoneal cavity accessible.

DESCRIPTION OF PROCEDURE:
Patient positioned supine with head turned left and right shoulder elevated. Right scalp, neck, chest, and right upper abdomen prepped in sterile fashion. Right frontal burr hole placed at Kocher's point (~11 cm posterior to nasion, 2.5-3 cm lateral to midline, 1 cm anterior to coronal suture) with high-speed drill. Dura cauterized and opened. A [medium pressure / programmable] [Medtronic Strata / Codman Hakim / Miethke proGAV / Sophysa Polaris] valve system prepared and flushed with antibiotic saline. Ventricular catheter passed [with / without] neuronavigation guidance toward ipsilateral frontal horn to *** cm depth. CSF return confirmed [clear / xanthochromic]. Catheter secured to valve at burr hole. Tunneled subcutaneously via retroauricular relay incision to small [right paramedian / right upper quadrant] abdominal incision. Peritoneum entered under direct visualization. Peritoneal catheter placed in right upper quadrant; free CSF flow confirmed; secured with purse-string suture. All wounds irrigated with antibiotic solution. Galea and skin closed in layers. Patient tolerated the procedure well.

ESTIMATED BLOOD LOSS: Minimal
SPECIMENS: CSF for cell count, protein, glucose, culture, and cytology
COMPLICATIONS: None
DRAINS: VP shunt system in place (valve setting: ***)
DISPOSITION: Patient taken to neurosurgical ICU/floor in stable condition.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Revision / proximal obstruction

CPT 62225 is specifically for ventricular (proximal) catheter replacement or irrigation (6.04 wRVU). CPT 62230 is for valve or distal catheter replacement (11.14 wRVU). When both components are replaced, bill 62225 + 62230 together. CPT 62258 (15.25 wRVU) for complete system replacement in one setting. Document which component was replaced and the CSF flow test result at each component prior to final assembly.

Endoscopic third ventriculostomy (ETV)

Alternative for obstructive hydrocephalus. CPT 62201 (15.64 wRVU). 62162 is colloid cyst excision, not ETV. Document endoscope entry, floor anatomy, stomal creation, and pulsatile flow confirmation.

Laparoscopic-assisted peritoneal catheter

For prior abdominal surgeries or obesity. Document laparoscopic visualization and catheter placement in right upper quadrant away from adhesions.

Charting Tips
  • Document valve type, model, and pressure setting
  • State Kocher's point or target used for ventricular catheter entry
  • Note CSF characteristics and send for routine studies + culture
  • Document catheter depth to first drainage hole
  • If programmable valve: document make, model, and initial pressure setting. Programmable valves are MR-conditional (NOT contraindicated for MRI — generally safe up to 3T). After any MRI, verify valve settings using shunt series X-ray or manufacturer-specific device and reprogram if changed. Magnet-resistant valves (Miethke proGAV 2.0, Sophysa Polaris) typically maintain settings post-MRI. Document initial setting in the operative note.
  • Peritoneal catheter length inserted into abdomen
Billing Tips
  • Bill 62223 for initial VP shunt creation (13.70 wRVU, 90-day global). For shunt revision: 62225 is for ventricular (proximal) catheter replacement or irrigation specifically (6.04 wRVU); 62230 is for replacement/revision of the valve or distal (peritoneal/atrial) catheter (11.14 wRVU).
  • When revision involves both the ventricular catheter and the distal catheter/valve, bill BOTH 62225 AND 62230 — not just 62230 alone. 62230 does not include the ventricular catheter; billing only 62230 for a complete shunt revision underbills the proximal component. Some payers require modifier -51 on the secondary code. Document each component replaced or revised separately.
  • Shunt infection requiring externalization followed by replacement: externalization is a complex billing scenario — 62256 (removal of complete shunt system without replacement, 7.20 wRVU) is appropriate when the entire hardware is removed. Externalization-only (distal end exteriorized but proximal system retained) does not map cleanly to 62256; confirm with your billing team. New shunt placement after infection clearance uses 62223 with a new global period.
  • 90-day global period: shunt series X-rays, programming adjustments, and neurologic checks are bundled. Shunt reservoir tap for CSF sampling or ICP measurement (61070, 0.87 wRVU) within the global period is separately billable. 62272 is a lumbar CSF drainage code, not a shunt tap.
  • Endoscopic third ventriculostomy (ETV, 62201, 15.64 wRVU) is an alternative to shunting for obstructive hydrocephalus — success is age- and etiology-dependent (ETVSS; best for aqueductal stenosis, >1 year of age; less effective in infants <6 months or post-hemorrhagic/post-infectious). Do not use shunt codes when ETV is performed.

General coding reference. Verify with your institution’s billing department before submitting claims.

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