Here is the op note for this. I am thinking 61888, 64553,64553-59 and 95975 but I have never coded for the Occipital Stimulator before.

PREOPERATIVE DIAGNOSIS: Chronic daily headache.

POSTOPERATIVE DIAGNOSIS: Chronic daily headache.

PROCEDURE: Removal of her previously placed implantable pulse generator and replacement with a new generator, Restore Ultra, and placement of two temporary peripheral nerve stimulator leads for relief of her chronic daily headaches.

ESTIMATED BLOOD LOSS: Less than 50 cc.

INDICATIONS FOR PROCEDURE: The patient is a 43-year-old female with a history of previous placement of bilateral occipital nerve stimulator leads for relief of chronic daily headaches. Her right side headache is covered, but she has continued pain over her left temple, as well as top of her skull. After discussing options with her, it was determined that we would proceed with replacement of her battery to see if her leads could be reprogrammed and if not, then we will place temporary leads over her temporalis muscle as well as the top of the skull. After discussing other options with her, it was determined we would proceed with such.

DESCRIPTION OF OPERATION: After adequate informed consent was obtained, the patient was taken to the operating room where she was placed in the prone position. Her back and neck as well as the left side of her face were prepped and draped in a sterile fashion. Under fluoroscopic guidance, her previously placed leads as well as extension connections were noted. Approximately 20 cc of a combination of 1:1 0.5% bupivacaine with 2% lidocaine with 1:200,000 epinephrine was injected subcutaneously over both of these areas. After adequate local analgesia was obtained, a 3-inch incision was made using both sharp and blunt dissection. This was carried to the level of her previously placed battery. Her Synergy battery was explanted and a new Restore Ultra battery was placed into the pocket. Her pocket was then connected to the extension with an extension kit, model #37082-60, serial #NKBO15084N, Restore Ultra model #37712, serial #NKF7148198 was utilized. At this point, we were able to obtain good coverage of her left side of her face. The wounds were closed using 3-0 Vicryl for deep and 4 0 Monocryl for her skin. A light pressure dressing was applied at this time.

Moving to an area behind her left temple as well as over the cap of her skull, approximately 2 cc of the above-mention local anesthetic mixture was injected subcutaneously and after local analgesia was obtained, a small stab incision was made with an #11 blade. A curved Tuohy needle was then placed subcutaneously over both of these areas. A Medtronic lead, model #3888, log #V052784 and #V226582, 56 cm in length was then advanced under fluoroscopic guidance via the needle over the areas of pain. Each of these was sewn in place with 0 braided nylon suture. A light pressure dressing was applied and the patient was log rolled to a supine position and taken to the recovery room in satisfactory condition.

Jenny, CPC