Melissa Harris CPC
Expert
I need help coding this procedure for nerve stimulator trial with 4 leads.
PROCEDURE: Boston Scientific NERVE STIMULATOR TRIAL
DIAGNOSIS:
722.4 - Intervertebral Disc Degeneration Cervical, 723.1 - Cervicalgia
INDICATIONS:Occipital Headache, Chronic Axial Neck Pain
ANESTHESIA: Local/Conscious sedation
DESCRIPTION OF PROCEDURE: With written and informed consent obtained, risk and benefits were discussed including but not limited to infection, post dural headache, temporary weakness/numbness of the arms, bone, nerve, spine damage, bleeding in the spine if taking ASA, NSAIDS, or blood thinners which can cause damage to the the spinal cord which can result in paralysis or death. Benefits are include pain relief. An IV was placed in the Left Antecubital and 1gram of Cefazolin was given in 250ml of Normal Saline. Per patient request, the patient was then administered 2 mL of 2 mg/2 mL midazolam IM by the nurse. The patient was then brought into the operating room. With monitors in place the patient was placed prone on the fluoroscopic operating room table. The area of the patient's neck and back of the head was first scrubbed, then prepped with alcohol, followed by betadine and drapped in a sterile surgical fashion. Strict sterile OR technique was followed for this procedure.
The occiput was then visualized. A skin wheal was raised just in the midline just below the inion with 4mL of 1% Lidocaine. Then a 14 gauge thuohy epidural needle was passed through the skin wheal and directed toward the right mastoid process. Once the tissue was entered, an 8 electrode spinal cord stimulator trial lead from Boston Scientific, model #SC-2352-50E, Lot # 381419 was advanced through the needle toward the inion fluoroscopically. AP view reveal that the 8 electrode lead was placed between the inion and the right mastoid process.
Then a second 14 gauge thuohy epidural needle was passed through the skin wheal and directed toward the left mastoid process. Once the tissue was entered, a second 8 electrode spinal cord stimulator trial lead from Boston Scientific , model #SC-2352-50E, Lot # 382962 was advanced through the needle toward the left inion fluoroscopically. AP view reveal that the 8 electrode lead was placed in the space between the inion and the left mastoid process.
Then I raised two skin wheals with 1% lidocaine, 4 mL at each skin wheal over the cervical paraspinal musculature at the C2 level approximately 2 cm from the midline.
I then directed a 14-gauge Touhy epidural needle downward through the skin and passed in a vertical direction parallel to the spinous processes just underneath the skin in the subcutaneous tissue spanning from C2-C4 on the right-hand side. I then did the same thing on the left-hand side with another 14-gauge Touhy epidural needle. I then inserted Boston Scientific spinal cord stimulator electrodes into each needle and fluoroscopically confirmed the electrode position as being between C2 and C4 in a vertical position just underneath the skin. The third 8 electrode spinal cord stimulator trial lead from Boston Scientific , model #SC-2352-50E, Lot # 381430. The fourth 8 electrode spinal cord stimulator trial lead from Boston Scientific , model #SC-2352-50E, Lot # 382815. These were parallel to one another and to the spinous processes in the midline.
At this point, under my direct supervision , the Boston Scientific representative began trial stimulation. Once this was deemed satisfactory, the needle and stylettes were removed from the patient, leaving the four 8 electrode leads in place. The leads were then fixed to the skin using a small plastic cuff over the exterior portion of the lead. A 2-0 silk suture on a curved cutting needle was placed through the cuff to the skin. Bacitracin ointment was applied to the puncture wounds and the whole system was held in place with benzoin and clear occlusive bandages. The patient was then brought to the recovery area in stable condition where once again stimulation was programmed under my direct supervision and with my input. The patient was given instructions to follow-up in the following week for stimulator removal and/or any problems that might arise.
64555 x 4 with 51 modifiers on the latter 3 codes? I received a denial on the latter two codes for duplicate.
Thank you!
Melissa Harris, CPC
PROCEDURE: Boston Scientific NERVE STIMULATOR TRIAL
DIAGNOSIS:
722.4 - Intervertebral Disc Degeneration Cervical, 723.1 - Cervicalgia
INDICATIONS:Occipital Headache, Chronic Axial Neck Pain
ANESTHESIA: Local/Conscious sedation
DESCRIPTION OF PROCEDURE: With written and informed consent obtained, risk and benefits were discussed including but not limited to infection, post dural headache, temporary weakness/numbness of the arms, bone, nerve, spine damage, bleeding in the spine if taking ASA, NSAIDS, or blood thinners which can cause damage to the the spinal cord which can result in paralysis or death. Benefits are include pain relief. An IV was placed in the Left Antecubital and 1gram of Cefazolin was given in 250ml of Normal Saline. Per patient request, the patient was then administered 2 mL of 2 mg/2 mL midazolam IM by the nurse. The patient was then brought into the operating room. With monitors in place the patient was placed prone on the fluoroscopic operating room table. The area of the patient's neck and back of the head was first scrubbed, then prepped with alcohol, followed by betadine and drapped in a sterile surgical fashion. Strict sterile OR technique was followed for this procedure.
The occiput was then visualized. A skin wheal was raised just in the midline just below the inion with 4mL of 1% Lidocaine. Then a 14 gauge thuohy epidural needle was passed through the skin wheal and directed toward the right mastoid process. Once the tissue was entered, an 8 electrode spinal cord stimulator trial lead from Boston Scientific, model #SC-2352-50E, Lot # 381419 was advanced through the needle toward the inion fluoroscopically. AP view reveal that the 8 electrode lead was placed between the inion and the right mastoid process.
Then a second 14 gauge thuohy epidural needle was passed through the skin wheal and directed toward the left mastoid process. Once the tissue was entered, a second 8 electrode spinal cord stimulator trial lead from Boston Scientific , model #SC-2352-50E, Lot # 382962 was advanced through the needle toward the left inion fluoroscopically. AP view reveal that the 8 electrode lead was placed in the space between the inion and the left mastoid process.
Then I raised two skin wheals with 1% lidocaine, 4 mL at each skin wheal over the cervical paraspinal musculature at the C2 level approximately 2 cm from the midline.
I then directed a 14-gauge Touhy epidural needle downward through the skin and passed in a vertical direction parallel to the spinous processes just underneath the skin in the subcutaneous tissue spanning from C2-C4 on the right-hand side. I then did the same thing on the left-hand side with another 14-gauge Touhy epidural needle. I then inserted Boston Scientific spinal cord stimulator electrodes into each needle and fluoroscopically confirmed the electrode position as being between C2 and C4 in a vertical position just underneath the skin. The third 8 electrode spinal cord stimulator trial lead from Boston Scientific , model #SC-2352-50E, Lot # 381430. The fourth 8 electrode spinal cord stimulator trial lead from Boston Scientific , model #SC-2352-50E, Lot # 382815. These were parallel to one another and to the spinous processes in the midline.
At this point, under my direct supervision , the Boston Scientific representative began trial stimulation. Once this was deemed satisfactory, the needle and stylettes were removed from the patient, leaving the four 8 electrode leads in place. The leads were then fixed to the skin using a small plastic cuff over the exterior portion of the lead. A 2-0 silk suture on a curved cutting needle was placed through the cuff to the skin. Bacitracin ointment was applied to the puncture wounds and the whole system was held in place with benzoin and clear occlusive bandages. The patient was then brought to the recovery area in stable condition where once again stimulation was programmed under my direct supervision and with my input. The patient was given instructions to follow-up in the following week for stimulator removal and/or any problems that might arise.
64555 x 4 with 51 modifiers on the latter 3 codes? I received a denial on the latter two codes for duplicate.
Thank you!
Melissa Harris, CPC