lwilcox

Looking for help on coding on 2 Spinal Cord Stimulator Revision Procedures. The 1st procedure done: Wanted to know if I can code them as 63650 as the primary code and then 63688 as the 2nd. This is a Medicare patient so no modifier would be needed. Procedure done:

Removal of Internal Pulse Generator

Revision of Generator Pocket

Removal of SCS lead x 1

Implantation of SCS lead x 1

Implantation of New Internal Pulse Generator/Boston Sci Spectra

Use of fluroscropy for radiographic guidance

Interpretation of radiographic pictures

Op description: The patient was brought to the opening room and was placed in the prone position. The patient's skin was prepped and drapped from the midthoracic through mid gluteal region. The region of previously implanted stimulator leads and generator were identified and marks were made over the previous incisions with the use of fluroscopic guidance. The skins was anesthetized with a combination of 1% lidocaine with eip, 0.25 marcaine and 8.4% bicarb. This previous incision for the generator and lead insertion site were opened using blunt and sharp dissection. Then the capsule surrounding the leads and internal pulse generator were identified dissected out. The generator retention suture was removed. The pulse generator was then removed from the pocket. The previous leads were diconnected from the generator. A testing cable was then connected to the previously implanted leads. A new lead was inserted at the T12/L1 level using a left paramedian approach and LOR technique through a 14ga touhy coude needle. The lead was advanced to the bottom of T6. The new lead and existing leads were connected to the spectra device and the patient was woken for testing. The far right lead was not needed. This lead was then removed. The newly implanted lead and previously implanted lead with anchored with 2 fixate devices. During anchoring one of the fixate device suture borke, this required opening another device. The patient then elected to have her generator changed to the new Boston scientific precision spectra internal pulse generator. The previous generator pocket was then revised and made deeper in order to accomodate the new generator. The new generato was interrogated.

Thank you for your help with this procedure

lwilcox

lwilcox