Hello all,
My provider did a replacement of a neurostimulator at an ASC and was wondering if the coding is correct?
Here's the report:
Postoperative Diagnoses:
1. Lumbago.
2. Peripheral nerve stimulator generator end-of-life failure.
Procedure:
1. Peripheral nerve stimulator generator replacement.
2. Generator pocket revision.
3. Complex stimulator analysis.
Anesthesia:
Monitored anesthesia care.
Estimated Blood Loss:
Minimal.
Complications:
None.
Drains:
None.
Specimens:
None.
Indications:
complicated history of low back pain with short-term response to multiple interventions for which a peripheral nerve stimulator was previously placed. The stimulator has helped to reduce pain and reduced medication intake. Unfortunately, the generator has reached its end-of-life as per a recent interrogation of the device and presents today for replacement of the generator. The replacement generator is larger than the current generator and pocket revision will be necessary.
Procedure:
The risks and benefits of the procedure were again reviewed in detail and informed consent was obtained. The patient was brought into the operating room and placed in the prone position. All pressure points were properly padded and the patient was secured. Monitored anesthesia care was administered. Prophylactic Ancef was administered. The area over the existing generator was prepped with chlorhexidine prep and draped in the usual sterile fashion. Time out for safety was taken. The area surrounding the existing horizontal incision site was anesthetized with 5 mL of 1% lidocaine with epinephrine. An #11-blade scalpel was then used to enter the skin along the existing scar and was extended approximately 3 mm beyond the edges of the existing scar to accommodate the new generator. Bovie cautery was then used to extend the incision down towards the existing generator pocket and good hemostasis was obtained. Metzenbaum scissors were used to open the existing pocket and this generator was removed and the leads were detached. The replacement non-rechargeable generator was then attached to the leads and secured in place. The existing pocket was then extended using Bovie cautery and Metzenbaum scissors inferiorly and superiorly to accommodate the larger generator. The generator was placed within the pocket and the generator was then interrogated under sterile conditions and found to be working appropriately. The generator was then removed and the pocket was irrigated with antibiotic solution several times. The pocket was found to be hemostatic. The generator was then replaced into the pocket and the edges of the pocket were reapproximated using 2-0 Vicryl sutures in an interrupted fashion. The skin was then reapproximated using 3-0 Vicryl sutures in an interrupted fashion. The skin was then closed with 4-0 Monocryl in a subcuticular fashion with Dermabond. The skin edges were well approximated on conclusion. There was excellent hemostasis. The skin was then dressed with Steri-Strips, gauze and Tegaderm. The anesthesia was discontinued. Fluoroscopic images were obtained. The patient was turned supine and brought to the recovery room. With the patient awake and communicative, the stimulator was again interrogated and four programs created based on the patient?s response to its pain control. The patient reported excellent return of her pain control coverage. The patient will follow up in approximately one week for re-evaluation.
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I came up with 63685, 95972, 77003-TC, C1778, and C1820. Am I missing anything else?
Thank you in advanced for your assistance!
My provider did a replacement of a neurostimulator at an ASC and was wondering if the coding is correct?
Here's the report:
Postoperative Diagnoses:
1. Lumbago.
2. Peripheral nerve stimulator generator end-of-life failure.
Procedure:
1. Peripheral nerve stimulator generator replacement.
2. Generator pocket revision.
3. Complex stimulator analysis.
Anesthesia:
Monitored anesthesia care.
Estimated Blood Loss:
Minimal.
Complications:
None.
Drains:
None.
Specimens:
None.
Indications:
complicated history of low back pain with short-term response to multiple interventions for which a peripheral nerve stimulator was previously placed. The stimulator has helped to reduce pain and reduced medication intake. Unfortunately, the generator has reached its end-of-life as per a recent interrogation of the device and presents today for replacement of the generator. The replacement generator is larger than the current generator and pocket revision will be necessary.
Procedure:
The risks and benefits of the procedure were again reviewed in detail and informed consent was obtained. The patient was brought into the operating room and placed in the prone position. All pressure points were properly padded and the patient was secured. Monitored anesthesia care was administered. Prophylactic Ancef was administered. The area over the existing generator was prepped with chlorhexidine prep and draped in the usual sterile fashion. Time out for safety was taken. The area surrounding the existing horizontal incision site was anesthetized with 5 mL of 1% lidocaine with epinephrine. An #11-blade scalpel was then used to enter the skin along the existing scar and was extended approximately 3 mm beyond the edges of the existing scar to accommodate the new generator. Bovie cautery was then used to extend the incision down towards the existing generator pocket and good hemostasis was obtained. Metzenbaum scissors were used to open the existing pocket and this generator was removed and the leads were detached. The replacement non-rechargeable generator was then attached to the leads and secured in place. The existing pocket was then extended using Bovie cautery and Metzenbaum scissors inferiorly and superiorly to accommodate the larger generator. The generator was placed within the pocket and the generator was then interrogated under sterile conditions and found to be working appropriately. The generator was then removed and the pocket was irrigated with antibiotic solution several times. The pocket was found to be hemostatic. The generator was then replaced into the pocket and the edges of the pocket were reapproximated using 2-0 Vicryl sutures in an interrupted fashion. The skin was then reapproximated using 3-0 Vicryl sutures in an interrupted fashion. The skin was then closed with 4-0 Monocryl in a subcuticular fashion with Dermabond. The skin edges were well approximated on conclusion. There was excellent hemostasis. The skin was then dressed with Steri-Strips, gauze and Tegaderm. The anesthesia was discontinued. Fluoroscopic images were obtained. The patient was turned supine and brought to the recovery room. With the patient awake and communicative, the stimulator was again interrogated and four programs created based on the patient?s response to its pain control. The patient reported excellent return of her pain control coverage. The patient will follow up in approximately one week for re-evaluation.
-------------
I came up with 63685, 95972, 77003-TC, C1778, and C1820. Am I missing anything else?
Thank you in advanced for your assistance!