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Peripheral Nerve or Peripheral Field Stimulator?

SAPERRINE

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The physician I work for is wanting this billed as a Peripheral Nerve Stimulator (64555). After reviewing the note below, this sounds more like Peripheral Field Stimulation (0282T) as a particular peripheral nerve is not targeted. Any help will be greatly appreciated.

PREOPERATIVE DIAGNOSIS:
1) CHRONIC PAIN SYNDROME
2) FAILED NECK SURGERY SYNDROME
3) CERVICAL RADICULOPATHY

POSTOPERATIVE DIAGNOSIS:
1) SAME

PROCEDURE(S):
1) Peripheral Nerve Stimulator Trial

COMPLICATIONS: None

INDICATIONS: Patient was recalcitrant to conservative interventions such as NSAID use and steroid tapers. She also had no sustained relief of pain following interventional procedures including epidural steroid injection, sympathetic nerve blocks, and/or joint injections.

PROCEDURE: Written informed consent was obtained and the patient understands risks and benefits of procedure(s). She was placed in a prone position and the skin over the lumbar back was prepped and draped in a sterile fashion using Hibiclens from the mid-thoracic spine to the occipital ridge. Fluoroscopy was used to identify the thoracic and cervical spine in an AP view. The skin and subcutaneous tissues at the intended needle entrance site was injected with 5ml 1% Lidocaine and 5ml of 0.5% Bupivicaine. The sites chosen were sites that are lateral and distal to the sacoriliac locations. A 14g 3.5 inch trochar needle was then advanced in a shallow paramedian fashion under direct fluoroscopic visualization starting from this entrance site. A Boston Scientific trial standard octad lead was then placed through the trochar needle and advanced under the skin so that it layed in an oblique direction subcutaneously over the C4-T1 levels. This lead was then connected for trial and the patient found the stimulation to cover the areas of her pain. She also found the stimulation to relieve his pain and found the stimulation sensation acceptable. The procedure was repeated for a second lead and which was placed under fluoroscopic visualization to lie in a similar position as the first lead but on the contralateral lumbar spine. This lead was also connected for trial and found to meet requirements of pain coverage, pain relief and the acceptable stimulation sensation.The needle(s) were then removed, verifying the leads remained in the tested positions after needle removal. The percutaneous exit site of the leads was then dressed with an opsite. No complications were noted, and the patient tolerated the procedure well without problems. The stimulator was then programmed after the trial for adequate coverage.
 

dwaldman

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AMA CPT Changes 2012



“Four Category III codes have been established for reporting peripheral field stimulation. Peripheral field stimulation is a new technology for the treatment of chronic cervical, thoracic, or lumbar pain. Electrode leads are placed in subcutaneous tissue around the painful area, and electrical current is applied to create stimulation in the area, or “field” of pain. This technique is different from peripheral nerve stimulation, in which specific peripheral nerves are targeted. In peripheral field stimulation, a field of pain is targeted rather than specific nerves. The elctrodes are placed in the skin either through an open or percutaneous approach. Imaging guidance is included, when performed.”
 

dwaldman

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Peipheral nerve stimulation PNS is for identifable nerve (such as sciatic nerve for patient with foot pain or occipital nerve for occiptial neuraglia) whereas peripheral nerve field stimulation involves subcutaneous placement of electical leads over generalized area of pain.

I saw the above in the following link and type it out the closest I could.

http://cpainmc.com/material/newsnarticles/NeurostimulationForPain.pdf

I understand 64555 for documentation that identifies the specific nerve the electrode is being placed over to treat where PNFS does not identify a specific nerve but location near the spine.
 

dwaldman

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Below is from CPT Changes 2012

Description of Procedure (0282T)
Prior to sedation, the area of pain is carefully outlined and patient receives preoperative intravenous antibiotics. Under sterile conditions, with minimal sedation and appropriate monitoring, a needle is placed subcutaneously, using a small amount of lidocaine at the insertion point. Subcutaneous electrode leads are placed centrally in the area of greatest pain. On-the-table stimulation ensures the correct depth of the leads and adequate stimulation over the area of pain. The leads are then sutured to the skin and dressing is applied. Average trial duration is five to seven days
 
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