A6-week-old baby had a cerebrospinal fluid shunt placed two days ago. the shunt is not draining the excess csf and the baby is returning to the or for shunt removal and replacement by the same surgeon who placed the original shunt. what cpt® code is reported for this surgery

The answer is cpt® code 62258-78. A complete removal of the cerebrospinal fluid shunt system with a replacement is performed. In the CPT® Index for Shunt/Brain/Removal codes 62256–62258, Modifier 78 is the suitable modifier to add for two reasons: (1) the patient returned to the operating room following the initial procedure during the postoperative period; (2) The same surgeon performed the initial procedure and the removal and replacement of the shunt.

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