Coding for fluoroscopy-guided contrast injection to evaluate a Denver shunt

Q.

Can you provide me with guidance on which CPT^® codes are correct to report for a fluoroscopic guided contrast injection for evaluation of a Denver shunt? CPT codes 49427, 75809 and 78291 all look relevant.

A.

CPT code 49427 is the correct code for the injection procedure. The correct imaging code depends on what was injected. Because your question states the patient was injected contrast, you would report CPT code 75809. If the patient had been injected a radiopharmaceutical instead of contrast, you would report CPT code 78291. The codes and full descriptions are as follows:

49427 Injection procedure (e.g., contrast media) for evaluation of previously placed peritoneal-venous shunt

75809 Shuntogram for investigation of previously placed indwelling nonvascular shunt (e.g., LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation

78291 Peritoneal-venous shunt patency test (e.g., for LeVeen, Denver shunt)