Help with spinal cord stimulator billing

alysonrs

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What procedure codes would be used for the following note?



Operation:

1.Fluroscopically guided placement single anterograde Boston Scientific 50 cm Infinion lead
2.Fluroscopic guidance with interpretation with multiplanar thoracic xeroradiography.
3.Intraoperative analysis and programming of lead
4.Intravenous conscious sedation

Anesthesia:
The patient was interviewed and examined and found to be a suitable candidate for intravenous conscious sedation. Intravenous conscious sedation was carried out along with appropriate monitoring using pulse oximetry, blood pressure, and EKG.

Indications:
This is a patient with Lumbar disc degeneration with intractable low back and radicular pain who presents today for a spinal cord stimulator trial in an effort to control the pain. The patient has been cleared in pre SCS psychologic evaluation

Details of Procedure:
Informed consent was obtained. The benefits, alternatives, and risks were discussed including, but not limited to, bleeding, infection, nerve injury, lack of pain relief, worsening of pain, seizure, paralysis, bowel and bladder dysfunction, and death. The patient chose to be brought to the procedure suite and was positioned with appropriate pressure points padded and comfortably awake. Monitors were placed and intravenous sedation was instituted. The patient was prepped and draped in strict sterile fashion. A multiplanar osseous screen was carried out over this anatomy to fluoroscopically identify the appropriate interlaminar space.

Using tunnel vision technique, the skin was marked and anesthetized the subcutaneous tissues for a paramedian approach to the T12/L1 foramen using loss of resistance technique with air and 14-gauge Tuohy needles. No CSF or blood and no paresthesia with loss of resistance and with placement of the needle.

One attempt on the right and two attempts on the left were required for one lead due to inability to steer the lead in the midline. Following identification of the epidural space, through the needle a Boston Scientific Infinion 50 cm. 16-contact trial lead was advanced in the midline in strict axial view until the 0 contact of the lead was at the top of the T7 vertebral shadow.

At this point analysis and programming was carried out using varying amplitude, pulse width, rate, frequency and polarity. We were able to achieve complete coverage of the patient's pain symptoms.

The needle and stylet were withdrawn. Hemostasis was observed. Antibiotic ointment was applied to the two puncture sites. The lead was secured to the skin with a StayFix pad. The area was taped.

The patient was taken to the recovery room and will be observed for an appropriate period of time and will be discharged when in stable condition with all recovery room criteria met. The patient will be given precautions regarding complications and be advised to call should these occur. We will see the patient back as scheduled for removal of the trial leads.

Specimens:
None

Complications:
None. Estimated blood loss: Minimal

Findings:
AP AND LATERAL THORACIC SPINE X-RAYS

Two views of the thoracic spine are submitted, demonstrating the lead to lie in the posterior epidural space. AP view shows the Zero contacts to be at the top of the T7 vertebral shadow to the left of the midline in strict axial view.

At final position final programming parameters yielded excellent coverage of the patient's pain.
Contacts 6-8
Rate 40
Pulse width3500
 

marvelh

Expert
Messages
304
Location
Denver Colorado
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63650 & 95971, fluoroscopic guidance and review is considered to be an inherent part of the percutaneous placement of the epidural lead
 
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