2025 CPT code 62252
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Reprogramming of a programmable cerebrospinal fluid shunt.
Modifiers such as 58 (staged or related procedure or service by the same physician during the postoperative period) or 25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure) may be appropriate in certain circumstances.Modifier 26 (professional component) may be used in situations where the physician bills separately for the professional component of the service.
Medical necessity is established by clinical evidence of shunt malfunction resulting in symptoms such as headaches, nausea, vomiting, altered mental status, or papilledema.The reprogramming is necessary to restore adequate CSF flow and alleviate clinical symptoms.
The physician's responsibility includes assessing the need for shunt reprogramming, adjusting the shunt's pressure setting using an external device, verifying the setting via imaging (e.g., X-ray), and ensuring the patient is stable post-procedure.
In simple words: The doctor adjusts a special shunt in your body that drains fluid from your brain. They do this without surgery, using a device placed on your skin to change the settings so the right amount of fluid drains.
This CPT code 62252 encompasses the non-invasive adjustment of a programmable shunt system's valve setting to correct over or under drainage of cerebrospinal fluid (CSF). The procedure involves using an external programming device to modify the pressure setting, aiming for optimal CSF flow.Verification of the new setting is typically done via X-ray to visualize the valve's position. This procedure is distinct from the initial shunt placement.
Example 1: A patient with a programmable VP shunt experiences increased headaches and symptoms suggestive of shunt malfunction.The physician performs a non-invasive reprogramming of the shunt to optimize CSF drainage. This is documented as a separate encounter., A patient with a history of normal pressure hydrocephalus and a programmable shunt undergoes a routine follow-up appointment.During the evaluation, the physician notes signs of over-drainage, and adjusts the shunt setting using the external programmer. This is documented, and the EM visit is coded separately., A patient receiving chemotherapy for a brain tumor experiences a decline in neurological status, potentially related to altered CSF dynamics due to the VP shunt.The physician re-programs the shunt to improve CSF flow.This is a medically necessary intervention related to the cancer treatment.
* Detailed patient history documenting symptoms indicating the need for shunt reprogramming (e.g., headaches, changes in mental status).* Pre and post-procedure imaging (X-rays) to verify shunt valve position and settings.* Documentation of the specific device and software used for the reprogramming.* Notes documenting the changes made to the shunt setting.* Detailed clinical note documenting the physician's assessment, plan, procedure, and post-procedure findings.
** Reprogramming of a programmable cerebrospinal fluid shunt is a distinct service from the initial implantation.Proper documentation is crucial for successful reimbursement.Specific payer policies and coding guidelines should always be referenced.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: Information not provided in source.Consult current Relative Value Units (RVUs) data from CMS or other relevant sources for accurate payment rates.
- Global Days: This procedure may be billed separately from the initial shunt placement, even within the global period. Modifier 58 may be needed if the reprogramming is considered an anticipated and integral part of the initial procedure.The exact global period will depend on the specific shunt placement code used.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier is generally not applicable to this code, as it's a physician-provided service.
- Fee Schedule: Historical fee schedule data is not available in the provided sources.Consult historical fee schedules from CMS or other relevant sources for historical reimbursement data.
- Specialties:Neurosurgery
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center