352 - Virtual Reality Dissociation as Alternative to Anesthesia/Sedation in Pediatric IR

Purpose: As of January 2024’s CPT Manual, physicians can report the use of virtual reality dissociation in aid of any other medical procedure. The codes are designed to mimic moderate sedation, and require an “independent, trained observer.” One year ago our 100% pediatric academic interventional radiology practice received grant funding to hire the nation’s first dedicated in-hospital virtual reality technologist to build out a VR dissociation program as an alternative to sedation and anesthesia for cases in pediatric IR. We report our experience.

Materials and Methods: A retrospective chart review was performed to identify cases where VR Dissociation (CPT 0771T) was reported. Intraprocedural documentation monitoring pain and anxiety were analyzed, as was subsequent reimbursement data. Descriptive statistics were performed.

Results: A total of 65 procedures that would have been offered with anesthesia were instead performed with VR dissociation. The youngest patient was 10 years old, oldest 24 years old, median and mean age 16 years old. Procedures included 19 FNAs, 18 LPs, 7 fluid aspirations, 6 tunneled CVC removals, 5 arthrograms, 4 nontunneled CVC placements, 2 tunneled CVC placements, 2 bleomycin sclerotherapies, 1 PICC placement, and 1 core needle biopsy. 43 procedures (66.2%) were reported to California Childcare Services, which currently maintains a blanket policy disallowing payment for all category 3 codes of this type. Of the remaining 22 cases, 7 (31.8%) have been successfully reimbursed thus far, with amounts ranging in value between $25.20 and $214.23 per case, comparable to moderate sedation codes. Remaining cases are pending claim resolution at this time.

Conclusion: VR Dissociation can be used as an alternative to anesthesia for a variety of IR procedures, and is reimbursable by private insurers at this time.