lcole7465
Expert
Our doctor removed both an SCS and a PNS from a patient. I know the codes for removal of the SCS are 63661 & 63688. I'm seeing the codes for the PNS are 64585 & 64595. I'm also seeing that the PNS removal codes are a Column 2 code to the SCS removal codes, but it showing that they can be unbundled. According to the operative report the stimulators were in 2 different anatomical areas. Can someone please verify if both should be coded:
PROCEDURE:
1. Removal of a spinal cord stimulator generator.
2. Removal of spinal cord stimulator leads x2 leads were removed from the posterior epidural space
3. Removal of peripheral nerve stimulator 3 leads were removed from the cervical subcutaneous tissue
4. Removal of peripheral nerve stimulator generator from the abdominal wall
5. Examination under fluoroscopy
COMPLICATIONS: None.
SPECIMENS: None.
PREPARATION OF THE PROCEDURE:
Oxygen saturation and vital signs were monitored continuously throughout the entire procedure in order to interact and give feedback. The x-ray technician was supervised and instructed to operate the fluoroscopy machine.
INFORMED CONSENT:
The risks, benefits and alternatives of the procedure were discussed with the patient. The patient was given opportunity to ask questions regarding the procedure, it's indications and the associated risks. The risks of the procedure discussed include infection, bleeding, allergic reaction, dural puncture, headache, nerve injuries, spinal cord injury, and cardiovascular and CNS side effects with possibility of vascular entry of medications. I also informed the patient of potential side effects or reactions to the medications potentially used during the procedure including sedatives, narcotics, anesthetics. The patient was informed both verbally and in writing. The patient understood the informed consent and desired to have the procedure performed.
DESCRIPTION OF PROCEDURE:
After written consent was obtained, the patient was brought to the operating room and was placed in the left lateral down position with all pressure points padded appropriately. General anesthesia was obtained. The patient was prepped and draped in the usual sterile fashion using chlorhexidine, and Ioban dressing was placed over the skin. After appropriate time-out and confirmation of preoperative antibiotics, fluoroscopy was used to identify the L1-2 intervertebral space and the anchors of the 2 leads. This area was then anesthetized with 20 mL of equal mixture of 1% lidocaine and 0.5% bupivacaine through a 27-gauge needle in the track leading towards the prevertebral fascia and also under the subcutaneous skin.
Then a 10-blade scalpel was used to incise the skin. Then sharp and blunt dissection was done down to the prevertebral fascia using electrocautery for hemostasis. Once the prevertebral fascia was encountered, I was able to identify the anchors that the securing the leads to the lumbar paraspinal fascia. I used sharp and blunt dissection and electrocautery to mobilize the anchors from the lumbar paraspinal fascia until the anchors of the lead were freely mobile.
Then under live fluoroscopy, we removed the lead from the epidural space. There was no resistance at all during the lead removal and also there is no paresthesia during the removal. Then, In the area of the battery, we used an 11 blade. After infiltrating the area with lidocaine 2% and bupivacaine 0.5%, we used an 11 blade and made transverse incision over the skin and subcutaneous tissues and used a sharp and blunt dissection until I exposed the battery. Then we removed the whole entire device after cutting the leads with heavy scissors. We confirmed under fluoroscopy there is no remnant left over from the devices on both sides. Then we irrigated both incisions. We closed the subcutaneous tissue with 2-0 Vicryl, followed by 3-0 Vicryl, and followed by 3-0 Monocryl. Skin glue was placed on both incisions. Tegaderm was placed on both incisions. Abdominal binder was placed.
Then we identified the subcutaneous leads under fluoroscopy. I infiltrated the area of the anchor of the subcutaneous leads with lidocaine 2% and bupivacaine 0.5% for skin infiltration then I used the 11 blade and made a transverse incision over the skin and subcutaneous tissue. Then I used a sharp and blunt dissection until I was able to expose the 3 anchors that was present in the subcutaneous tissues. I used the sharp and blunt dissection until the 3 anchors were freed and moved freely. Then under live fluoroscopy we removed the 3 anchors from the subcutaneous tissue. Then there was a anchor over the extension that was present at the level of the right axillary line. I infiltrated the area with lidocaine 1% and bupivacaine 0.5% equal volume. I used an 11 blade and made a transverse incision over the skin and subcutaneous tissue. I used a sharp and blunt dissection until I was able to free the anchors and and they were freely movable. I pulled the anchor out from the cervical spine incision. Then we paid our attention to the abdominal wall battery. I infiltrated the area with lidocaine 1% and bupivacaine 0.5% equal volumes. I made a transverse incision over the skin and subcutaneous tissue at the I was able to expose the battery and extension that was connected to the battery. Then I pulled the whole entire system from the mid axillary line to the abdominal wall. I irrigated all the 5 incisions. I closed the subcutaneous tissue with 2-0 Vicryl followed by 3-0 Vicryl followed by 3-0 Monocryl. Skin glue was placed on all the 5 incisions. CH G dressing was placed on all the 5 incisions. The patient was doing well postoperatively.
PROCEDURE:
1. Removal of a spinal cord stimulator generator.
2. Removal of spinal cord stimulator leads x2 leads were removed from the posterior epidural space
3. Removal of peripheral nerve stimulator 3 leads were removed from the cervical subcutaneous tissue
4. Removal of peripheral nerve stimulator generator from the abdominal wall
5. Examination under fluoroscopy
COMPLICATIONS: None.
SPECIMENS: None.
PREPARATION OF THE PROCEDURE:
Oxygen saturation and vital signs were monitored continuously throughout the entire procedure in order to interact and give feedback. The x-ray technician was supervised and instructed to operate the fluoroscopy machine.
INFORMED CONSENT:
The risks, benefits and alternatives of the procedure were discussed with the patient. The patient was given opportunity to ask questions regarding the procedure, it's indications and the associated risks. The risks of the procedure discussed include infection, bleeding, allergic reaction, dural puncture, headache, nerve injuries, spinal cord injury, and cardiovascular and CNS side effects with possibility of vascular entry of medications. I also informed the patient of potential side effects or reactions to the medications potentially used during the procedure including sedatives, narcotics, anesthetics. The patient was informed both verbally and in writing. The patient understood the informed consent and desired to have the procedure performed.
DESCRIPTION OF PROCEDURE:
After written consent was obtained, the patient was brought to the operating room and was placed in the left lateral down position with all pressure points padded appropriately. General anesthesia was obtained. The patient was prepped and draped in the usual sterile fashion using chlorhexidine, and Ioban dressing was placed over the skin. After appropriate time-out and confirmation of preoperative antibiotics, fluoroscopy was used to identify the L1-2 intervertebral space and the anchors of the 2 leads. This area was then anesthetized with 20 mL of equal mixture of 1% lidocaine and 0.5% bupivacaine through a 27-gauge needle in the track leading towards the prevertebral fascia and also under the subcutaneous skin.
Then a 10-blade scalpel was used to incise the skin. Then sharp and blunt dissection was done down to the prevertebral fascia using electrocautery for hemostasis. Once the prevertebral fascia was encountered, I was able to identify the anchors that the securing the leads to the lumbar paraspinal fascia. I used sharp and blunt dissection and electrocautery to mobilize the anchors from the lumbar paraspinal fascia until the anchors of the lead were freely mobile.
Then under live fluoroscopy, we removed the lead from the epidural space. There was no resistance at all during the lead removal and also there is no paresthesia during the removal. Then, In the area of the battery, we used an 11 blade. After infiltrating the area with lidocaine 2% and bupivacaine 0.5%, we used an 11 blade and made transverse incision over the skin and subcutaneous tissues and used a sharp and blunt dissection until I exposed the battery. Then we removed the whole entire device after cutting the leads with heavy scissors. We confirmed under fluoroscopy there is no remnant left over from the devices on both sides. Then we irrigated both incisions. We closed the subcutaneous tissue with 2-0 Vicryl, followed by 3-0 Vicryl, and followed by 3-0 Monocryl. Skin glue was placed on both incisions. Tegaderm was placed on both incisions. Abdominal binder was placed.
Then we identified the subcutaneous leads under fluoroscopy. I infiltrated the area of the anchor of the subcutaneous leads with lidocaine 2% and bupivacaine 0.5% for skin infiltration then I used the 11 blade and made a transverse incision over the skin and subcutaneous tissue. Then I used a sharp and blunt dissection until I was able to expose the 3 anchors that was present in the subcutaneous tissues. I used the sharp and blunt dissection until the 3 anchors were freed and moved freely. Then under live fluoroscopy we removed the 3 anchors from the subcutaneous tissue. Then there was a anchor over the extension that was present at the level of the right axillary line. I infiltrated the area with lidocaine 1% and bupivacaine 0.5% equal volume. I used an 11 blade and made a transverse incision over the skin and subcutaneous tissue. I used a sharp and blunt dissection until I was able to free the anchors and and they were freely movable. I pulled the anchor out from the cervical spine incision. Then we paid our attention to the abdominal wall battery. I infiltrated the area with lidocaine 1% and bupivacaine 0.5% equal volumes. I made a transverse incision over the skin and subcutaneous tissue at the I was able to expose the battery and extension that was connected to the battery. Then I pulled the whole entire system from the mid axillary line to the abdominal wall. I irrigated all the 5 incisions. I closed the subcutaneous tissue with 2-0 Vicryl followed by 3-0 Vicryl followed by 3-0 Monocryl. Skin glue was placed on all the 5 incisions. CH G dressing was placed on all the 5 incisions. The patient was doing well postoperatively.