Ckrogers
Contributor
Pt has OAB symptoms. She had an Interstim placed a number of years ago. The generator life is nearly complete and the lead is not MRI compatible. She presents for removal and replacement.
Procedure:
The incision was opened and the generator removed. Then the incision overlying the insertion site of the lead was opened. The lead was grasped and removed intact.
Under fluoroscopic guidance the bony landmarks were identified. The skin under the insertion site was anesthetized with 1% lidocaine. The finder needle was then passed through the S3 foramen on the both sides. Position was confirmed fluoroscopically. She had an appropriate motor and sensory response bilaterally but was present at lower amplitude on the right. We elected to place the lead on the right. The needle was then exchanged for the introducer and the lead was placed with a slight lateral curve on the right. All 4 lead positions were tested and had an appropriate response. Anesthesia was then administered. The lead was tunneled to the pocket and attached to the generator. The pocket was irrigated with antibiotic irrigant. The generator was placed in the pocket and tested for the correct resistance. When this was confirmed the pocket was irrigated. The incisions were closed in 2 layers and she was taken to day surgery in good condition after dressings were placed.
The revised and new codes are almost interchangeable. I am leaning toward 0816T, or 64596. Any advice appreciated.
Procedure:
The incision was opened and the generator removed. Then the incision overlying the insertion site of the lead was opened. The lead was grasped and removed intact.
Under fluoroscopic guidance the bony landmarks were identified. The skin under the insertion site was anesthetized with 1% lidocaine. The finder needle was then passed through the S3 foramen on the both sides. Position was confirmed fluoroscopically. She had an appropriate motor and sensory response bilaterally but was present at lower amplitude on the right. We elected to place the lead on the right. The needle was then exchanged for the introducer and the lead was placed with a slight lateral curve on the right. All 4 lead positions were tested and had an appropriate response. Anesthesia was then administered. The lead was tunneled to the pocket and attached to the generator. The pocket was irrigated with antibiotic irrigant. The generator was placed in the pocket and tested for the correct resistance. When this was confirmed the pocket was irrigated. The incisions were closed in 2 layers and she was taken to day surgery in good condition after dressings were placed.
The revised and new codes are almost interchangeable. I am leaning toward 0816T, or 64596. Any advice appreciated.