Melissa Harris CPC
Expert
Hello,
Can someone direct me in how to bill this? Two leads were placed but then one was removed and another implanted.
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 Vancomycin 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 entire 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 technique was followed for this procedure.
The C2 interspace was then visualized. Skin wheals were raised Right and Left of this region using up to 5 of 1% Lidocaine. Another 4-5mL was used to infiltrate subcutaneous tissue using a 25 guage, 1.5 inch needle. Then a 3.5 inch 14 gauge thuohy epidural needle was passed through the skin wheals from a caudad to cephalad direction subcutaneously on both sides . Once the space was entered, an 8 electrode spinal cord stimulator trial lead from Boston Scientific , model # SC-2352-50E, Lot # 16191824 was advanced up to the mastoid process bilaterally. Both AP and lateral views reveal that the 8 electrode lead were placed in the correct position. At this point, under my direct supervision , the Boston Scientific representative began trial stimulation. Once satisfactory, a second 8 electrode lead, using the same model # was passed through a new 14-gauge thouhy epidural needle and directed toward the correct position. Utilizing fluoroscopic guidance the same technique was utilized . Once both leads were in place and checked in an AP and lateral views, again under my direct supervision stimulation is begun. Once this was deemed satisfactory, the needle and stylettes were removed from the patient, leaving the two 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. At this point, the patient had suboptimal stimulation, therefore she was brought back to the operating room table and a third 8 electrode lead, using the same model # was passed through a new 14-gauge thouhy epidural needle and directed toward the correct position. Utilizing fluoroscopic guidance the same technique was utilized . Once all leads were in place and checked in an AP and lateral views, again under my direct supervision stimulation is begun. Once this was deemed satisfactory, the needle and stylettes were removed from the patient, leaving eventually two 8 electrode leads in place, which gave the best stimulation for the patient, removing the third electrode after intraoperative testing. 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 given instructions to follow-up in the following week for stimulator removal and/or any problems that might arise.
Any help is greatly appreciated
Melissa Harris, CPC
Can someone direct me in how to bill this? Two leads were placed but then one was removed and another implanted.
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 Vancomycin 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 entire 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 technique was followed for this procedure.
The C2 interspace was then visualized. Skin wheals were raised Right and Left of this region using up to 5 of 1% Lidocaine. Another 4-5mL was used to infiltrate subcutaneous tissue using a 25 guage, 1.5 inch needle. Then a 3.5 inch 14 gauge thuohy epidural needle was passed through the skin wheals from a caudad to cephalad direction subcutaneously on both sides . Once the space was entered, an 8 electrode spinal cord stimulator trial lead from Boston Scientific , model # SC-2352-50E, Lot # 16191824 was advanced up to the mastoid process bilaterally. Both AP and lateral views reveal that the 8 electrode lead were placed in the correct position. At this point, under my direct supervision , the Boston Scientific representative began trial stimulation. Once satisfactory, a second 8 electrode lead, using the same model # was passed through a new 14-gauge thouhy epidural needle and directed toward the correct position. Utilizing fluoroscopic guidance the same technique was utilized . Once both leads were in place and checked in an AP and lateral views, again under my direct supervision stimulation is begun. Once this was deemed satisfactory, the needle and stylettes were removed from the patient, leaving the two 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. At this point, the patient had suboptimal stimulation, therefore she was brought back to the operating room table and a third 8 electrode lead, using the same model # was passed through a new 14-gauge thouhy epidural needle and directed toward the correct position. Utilizing fluoroscopic guidance the same technique was utilized . Once all leads were in place and checked in an AP and lateral views, again under my direct supervision stimulation is begun. Once this was deemed satisfactory, the needle and stylettes were removed from the patient, leaving eventually two 8 electrode leads in place, which gave the best stimulation for the patient, removing the third electrode after intraoperative testing. 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 given instructions to follow-up in the following week for stimulator removal and/or any problems that might arise.
Any help is greatly appreciated
Melissa Harris, CPC