Summary & Overview
CPT 63746: Removal of Lumbar Subarachnoid CSF Shunt
CPT code 63746 designates the surgical removal of a previously implanted lumbar subarachnoid shunt that drains cerebrospinal fluid (CSF) from the subarachnoid space. This procedure is clinically significant because shunt removal may be required for malfunction, infection, migration, or other complications and can have implications for patient outcomes, perioperative management, and utilization of surgical resources nationwide. Payors and policymakers monitor utilization and coding of explantation procedures to align coverage policies, prior authorization rules, and quality oversight with clinical guidelines.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 63746, typical sites of service, and the operational considerations relevant to billing and reimbursement. The publication summarizes benchmarks where available, highlights common modifier use and billing considerations (Data not available in the input for payer-specific rates), and outlines how the code fits within surgical service lines for neurosurgery and spine care. The content is intended to inform coding professionals, revenue cycle teams, and health policy stakeholders about the primary uses and administrative context of CPT code 63746 at a national level.
Billing Code Overview
CPT code 63746 describes the surgical removal of a previously implanted lumbar subarachnoid shunt used to drain cerebrospinal fluid (CSF) from the subarachnoid space surrounding the spinal cord. The procedure involves explantation of a small tube placed in the lumbar region near the base of the lumbar spine.
Service type: Surgical explantation of lumbar subarachnoid CSF shunt
Typical site of service: Operating room or inpatient surgical setting, with potential performance in an outpatient surgical center depending on clinical factors and payer policies.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with a previously implanted lumbar subarachnoid shunt for treatment of chronic cerebrospinal fluid (CSF) leak presents with new localized pain at the lumbar implantation site, recurrent headaches, and signs suggesting shunt malfunction and possible infection. After evaluation by a neurosurgeon — including history, focused neurologic exam, wound inspection, basic laboratory testing, and imaging (noncontrast CT or MRI spine as indicated) — the decision is made to remove the existing lumbar subarachnoid shunt. The procedure is performed in an operating room or ambulatory surgical center under general or monitored anesthesia care. The workflow includes preoperative consent and antibiotics when indicated, positioning in the prone position, sterile prep and drape, incision over the shunt, careful dissection to the shunt tubing and connector, removal of the implanted tubing and any anchoring devices, inspection of CSF for evidence of infection or ongoing leak, hemostasis, layered wound closure, and postoperative monitoring for neurologic or CSF leak complications. Typical postoperative documentation includes the indication for removal, operative findings, estimated blood loss, implants removed, disposition, and specific operative technique. Typical sites of service are the hospital operating room or an ambulatory surgery center. The service type is a surgical removal of an implanted cerebrospinal fluid drainage device from the lumbar subarachnoid space, corresponding to 63746.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |