Ventriculoperitoneal Shunt (VP Shunt)

CPT 62223
Approach Open
Add-on / Variant CPTs
  • 62225 — VP shunt revision
  • 62230 — Shunt replacement or irrigation
  • 62220 — Ventriculoatrial shunt
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
Patient supine, head turned to left, right shoulder elevated. Right-sided placement standard.

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 parietal burr hole was placed at [Kocher's point: 10.5 cm posterior to the nasion, 3 cm lateral to midline] using a high-speed drill. The dura was cauterized and opened sharply. A [medium pressure / programmable] [Medtronic Strata / Codman Hakim / Integra] 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.
A retroauricular incision was made and tunneled subcutaneously to a right subcostal abdominal incision. The peritoneal catheter was passed into the subcutaneous tunnel. A small right subcostal laparotomy was performed, and the peritoneum entered under direct visualization. The peritoneal catheter was placed and secured with a pursestring 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 parietal burr hole placed at Kocher's point (10.5 cm posterior to nasion, 3 cm lateral to midline) with high-speed drill. Dura cauterized and opened. A [medium pressure / programmable] [Medtronic Strata / Codman Hakim] 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. Retroauricular incision made and subcutaneous tunnel created to right subcostal abdominal incision. Small subcostal laparotomy performed. Peritoneum entered under direct visualization. Peritoneal catheter placed and 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. Document which component replaced (ventricular catheter, valve, or peritoneal catheter). Document CSF flow test at each component.

Endoscopic third ventriculostomy (ETV)

Alternative for obstructive hydrocephalus. CPT 62162. 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 initial setting and need for postoperative MRI avoidance
  • Peritoneal catheter length inserted into abdomen
Billing Tips
  • Bill 62220 for ventriculoperitoneal shunt creation (13.75 wRVU, 90-day global). Bill 62230 for shunt replacement or revision (11.14 wRVU, 90-day global). Use 62220 only for initial shunt placement. Revisions always use 62230.
  • When revision involves both the ventricular catheter and peritoneal catheter, bill 62230 for the entire revision. Do not bill separate codes for each component replaced. One code covers the entire shunt revision.
  • Shunt externalization (for infection) followed by replacement at a later date: externalization uses 62256 (removal, 7.94 wRVU) and new shunt placement uses 62220. These are separate procedures with separate global periods.
  • 90-day global period: shunt series X-rays, ICP monitoring, and neurologic checks are bundled. Shunt tap for diagnostic ICP measurement (62272, 2.24 wRVU) within the global period may be separately billable. Confirm with your billing team.
  • Endoscopic third ventriculostomy (ETV, 62160) is an alternative to shunting and uses a distinct code family. Do not use shunt codes when ETV is the procedure performed.