Summary & Overview
CPT 62190: Cerebrospinal Fluid Shunt to Cardiac or Jugular Drainage
CPT code 62190 covers surgical placement of a cerebrospinal fluid shunt to drain subarachnoid or subdural fluid into a cardiac atrial chamber, the jugular vein, or a heart auricle. This neurosurgical procedure is clinically significant because it addresses elevated intracranial pressure and symptomatic hydrocephalus, conditions with potential for acute neurologic deterioration and long-term disability if untreated. Nationally, management of cerebrospinal fluid disorders represents a critical intersection of surgical care, device use, and payer coverage policy.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and typical settings for the service, followed by benchmarking and coverage perspectives where available. The publication highlights common billing modifiers associated with surgical services, outlines expected sites of service, and summarizes the clinical context for when a shunt to a cardiac or jugular destination is used.
Intended takeaways include understanding what CPT code 62190 represents, the clinical scenarios that prompt its use, how major payers approach this category of neurosurgical devices and procedures, and where to look for policy or reimbursement guidance. Data not available in the input will be explicitly noted in relevant sections.
Billing Code Overview
CPT code 62190 describes the surgical insertion of a shunt to drain cerebrospinal fluid that has accumulated beneath the arachnoid or dural membranes covering the brain. The procedure establishes a pathway for excess fluid to be diverted to a cardiac chamber or major venous outflow, reducing intracranial pressure and treating symptomatic hydrocephalus or related cerebrospinal fluid disorders.
-
Service type: Surgical cerebrospinal fluid shunt placement
-
Typical site of service: Inpatient or outpatient hospital operating room; may also be performed in specialized ambulatory surgical centers for selected patients
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting with symptoms of increased intracranial pressure such as progressive headache, nausea/vomiting, gait disturbance, cognitive decline, or visual changes. Imaging (CT or MRI) demonstrates ventriculomegaly consistent with communicating or noncommunicating hydrocephalus. The neurosurgical team evaluates risks and confirms indications for permanent cerebrospinal fluid diversion. After preoperative assessment and informed consent, the patient is brought to the operating room for implantation of a ventriculoatrial shunt: a catheter is tunneled subcutaneously from a cranial ventricular catheter to the internal jugular vein or directly into the right atrium, with connection to a valve reservoir. Intraoperative steps include ventricular catheter placement (often with stereotactic or freehand technique), tunneling of the distal catheter, central venous access (percutaneous or cutdown), confirmation of catheter tip position (fluoroscopy, chest x-ray), and securement of the system. Postoperative workflow includes chest radiograph to confirm tip location and rule out complications, neurologic monitoring for symptom improvement or complications (infection, hemorrhage, shunt malfunction, thromboembolism), and coordination with case management for discharge planning and follow-up neurosurgical clinic visits.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | When two surgeons of different specialties participate substantially, each performing distinct portions of the operation. |