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.