CCANTER
Networker
- Messages
- 95
- Location
- Dalton, NE
I am only needing help with whether i could possibly bill cpt code 64595. the provider removed a sacral lead and placed a new lead. The provider also opened existing implantable pulse generator pock with lead disconnection and reconnection to new lead which did involve removing the neurostimulator and putting it back in after checking settings. The provider though didn't actually revise the device.
My question is am i able to bill cpt code 64595 for this as well as the other codes?
here is note
Procedures Performed:
1. Removal of existing sacral neuromodulation lead
2. Percutaneous placement of new left S3 tined sacral neuromodulation lead under fluoroscopic guidance
3. Opening of existing implantable pulse generator pocket with lead disconnection and reconnection to new lead
4. Intraoperative fluoroscopy with interpretation
5. Intraoperative device testing and impedance check
The prior IPG incision in the right upper buttock was infiltrated with 0.25% bupivacaine and opened sharply. The pocket was developed with electrocautery, and the IPG was delivered. The existing lead was disconnected from the IPG header. Under fluoroscopy, the existing lead was seen retracted from the S3 foramen. It was removed with gentle, steady traction intact with all tines and electrodes visualized.
AP and lateral fluoroscopy were used to identify the left S3 foramen. The skin and needle tract were infiltrated with local anesthetic. The foramen needle was advanced into the S3 foramen, confirmed on lateral fluoroscopy, and stimulated. This produced pelvic floor bellows response and ipsilateral great toe plantar flexion. The stylet was removed, and a directional guidewire was placed. A small skin incision was made, and the dilator and introducer sheath were advanced over the guidewire into the foramen under fluoroscopy. The new Axonics tined lead was passed through the sheath and positioned so the electrodes spanned the ventral sacral surface, with the characteristic curve seen on lateral fluoroscopy. Each electrode was tested, with appropriate responses. The sheath was withdrawn under fluoroscopy to deploy the tines, and final position was confirmed on AP and lateral images.
The lead was tunneled subcutaneously from the sacral incision to the IPG pocket and connected to the IPG header. The set screw was tightened with the torque wrench until it clicked. Impedance testing by the Axonics representative was within normal limits on all electrodes. The IPG was returned to the pocket with excess lead coiled behind it. All incisions were irrigated. The IPG pocket was closed in layers with subcuticular suture, and the sacral lead incision was closed. Dermabond and Mepilex dressings were applied. Sponge, needle, and instrument counts were correct. .
Findings:
1. Existing sacral lead retracted from S3 foramen on intraoperative fluoroscopy, consistent with post-traumatic migration
2. Existing lead removed intact
3. New lead placed in left S3 foramen with motor responses; final position confirmed on AP and lateral fluoroscopy
4. Normal impedances on all electrodes after connection to existing IPG
5. No evidence of pocket infection, seroma, or erosion
My question is am i able to bill cpt code 64595 for this as well as the other codes?
here is note
Procedures Performed:
1. Removal of existing sacral neuromodulation lead
2. Percutaneous placement of new left S3 tined sacral neuromodulation lead under fluoroscopic guidance
3. Opening of existing implantable pulse generator pocket with lead disconnection and reconnection to new lead
4. Intraoperative fluoroscopy with interpretation
5. Intraoperative device testing and impedance check
The prior IPG incision in the right upper buttock was infiltrated with 0.25% bupivacaine and opened sharply. The pocket was developed with electrocautery, and the IPG was delivered. The existing lead was disconnected from the IPG header. Under fluoroscopy, the existing lead was seen retracted from the S3 foramen. It was removed with gentle, steady traction intact with all tines and electrodes visualized.
AP and lateral fluoroscopy were used to identify the left S3 foramen. The skin and needle tract were infiltrated with local anesthetic. The foramen needle was advanced into the S3 foramen, confirmed on lateral fluoroscopy, and stimulated. This produced pelvic floor bellows response and ipsilateral great toe plantar flexion. The stylet was removed, and a directional guidewire was placed. A small skin incision was made, and the dilator and introducer sheath were advanced over the guidewire into the foramen under fluoroscopy. The new Axonics tined lead was passed through the sheath and positioned so the electrodes spanned the ventral sacral surface, with the characteristic curve seen on lateral fluoroscopy. Each electrode was tested, with appropriate responses. The sheath was withdrawn under fluoroscopy to deploy the tines, and final position was confirmed on AP and lateral images.
The lead was tunneled subcutaneously from the sacral incision to the IPG pocket and connected to the IPG header. The set screw was tightened with the torque wrench until it clicked. Impedance testing by the Axonics representative was within normal limits on all electrodes. The IPG was returned to the pocket with excess lead coiled behind it. All incisions were irrigated. The IPG pocket was closed in layers with subcuticular suture, and the sacral lead incision was closed. Dermabond and Mepilex dressings were applied. Sponge, needle, and instrument counts were correct. .
Findings:
1. Existing sacral lead retracted from S3 foramen on intraoperative fluoroscopy, consistent with post-traumatic migration
2. Existing lead removed intact
3. New lead placed in left S3 foramen with motor responses; final position confirmed on AP and lateral fluoroscopy
4. Normal impedances on all electrodes after connection to existing IPG
5. No evidence of pocket infection, seroma, or erosion