laurenwilcox10
New
Need assistance on what CPT codes to use on this SCS Revision procedure, including if a modifier would be required. The provider removed 2 precision batteries and then installed a new spectra generator and worked on the leads. The payer is Medicare Part B primary, secondary Medicaid. Would I be able to use CPT 63688 (Revision/removal of implanted spinal neurostimulaor pulse generator or receiver) and CPT 63685 (insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling) together? *Note (Do not report 63685 in conjunction w/63688 for the same pulse generator or receiver) Can I use CPT 63688, 63685 and 63663 with 95972? Please advise.
Procedure Note:
1. Removal of Internal Pulse Generator x 2
2. Revision of Generator Pocket
3. Implantation of new internal pulse generator/Boston Sci Spectra
4. Use of fluroscopy for radiographic guidance
5. Interpretation of radiographic pictures
Op Description: the patient was brought to the operating room and was placed in the prone position. The patient's skin was prepped and drapped from the upper thoracic through mid gluteal region. The region of previously implanted stimulator leads and generator were identified and marks were made over the previous incisions with the use of fluroscopic guidance. The skin was anesthesized wih a combination of 1% lidocaine with eip, 0.25% marcaine and 8.4% bicarb. This previous generator pocket incision was opened using a blunt and sharp dissection. The capsule surrounding the internal pulse generator was identified and opened. The generator was dissected out and retention suture was removed. The pulse generator was then removed from the pocket and removed in its entirety. The previous leads were disconnected from the generator. A testing cable was then connected to the previously implanted leads. The patient was woken from sedation and had on the table testing using the Boston Scientific observational mechanical gateway system. The patient did receive adequate paresthesias in the neck and upper extremities. The patient stated that the stimulation was much better than the previous generator and there was better coverage in the pain pattern. The patient then elected to have generator changed to the new Boston scientific precision spectra internal pulse generator. The previously implanted generator for the thoracic system was identified with fluroscopic guidance. The pocket was anesthetized and was opened using sharp and blunt dissection. The previously implanted generator was removed in its entirety. A tunneling device was then used to connect this pocket to the pocket that had been created for the cervical stimulator system. The extension set that had or even connected to the previously implanted cervical stimulator leads was passed through the tunneling device in to the pocket that had been created for the thoracic system. The previous generator pocket was then revised in order to accommodate the new generator along with the use of 2 extension sets. The new generator was interrogated. All of the connections were verified and impedances were checked. The previous cervical generator pocket and the newly revised lumbar pocket were then washed out with a generous amoint of solution containing vancomycin.
Thank you.
Procedure Note:
1. Removal of Internal Pulse Generator x 2
2. Revision of Generator Pocket
3. Implantation of new internal pulse generator/Boston Sci Spectra
4. Use of fluroscopy for radiographic guidance
5. Interpretation of radiographic pictures
Op Description: the patient was brought to the operating room and was placed in the prone position. The patient's skin was prepped and drapped from the upper thoracic through mid gluteal region. The region of previously implanted stimulator leads and generator were identified and marks were made over the previous incisions with the use of fluroscopic guidance. The skin was anesthesized wih a combination of 1% lidocaine with eip, 0.25% marcaine and 8.4% bicarb. This previous generator pocket incision was opened using a blunt and sharp dissection. The capsule surrounding the internal pulse generator was identified and opened. The generator was dissected out and retention suture was removed. The pulse generator was then removed from the pocket and removed in its entirety. The previous leads were disconnected from the generator. A testing cable was then connected to the previously implanted leads. The patient was woken from sedation and had on the table testing using the Boston Scientific observational mechanical gateway system. The patient did receive adequate paresthesias in the neck and upper extremities. The patient stated that the stimulation was much better than the previous generator and there was better coverage in the pain pattern. The patient then elected to have generator changed to the new Boston scientific precision spectra internal pulse generator. The previously implanted generator for the thoracic system was identified with fluroscopic guidance. The pocket was anesthetized and was opened using sharp and blunt dissection. The previously implanted generator was removed in its entirety. A tunneling device was then used to connect this pocket to the pocket that had been created for the cervical stimulator system. The extension set that had or even connected to the previously implanted cervical stimulator leads was passed through the tunneling device in to the pocket that had been created for the thoracic system. The previous generator pocket was then revised in order to accommodate the new generator along with the use of 2 extension sets. The new generator was interrogated. All of the connections were verified and impedances were checked. The previous cervical generator pocket and the newly revised lumbar pocket were then washed out with a generous amoint of solution containing vancomycin.
Thank you.