I think that only CPT 64585 should be billed for the following procedure based on NCCI edits. Even though 64555 has a higher RVU it hits an edit with 64585. Please advise if you would bill 64555 as well with an XS modifier. This is the first time we have seen a revision of a peripheral neurostimulator at our ASC. I appreciate any guidance you can offer.
POSTOPERATIVE DIAGNOSES: 1. Broken right superomedial genicular nerve peripheral neurostimulator lead.2. Right superomedial genicular nerve mononeuropathy.
OPERATIONS PERFORMED: 1. Revision right superomedial genicular nerve peripheral neurostimulator lead. 2. Implantation of peripheral neurostimulator lead, right superomedial genicular nerve.
Given his medical background and potential for longer procedure, a short-acting spinal was placed. The operative time-out was performed with all members of the operating room staff confirming patient, procedure, side, and site. Preoperative antibiotics were administered. The transverse incision was made over the initial insertion site about 10-15 cm proximal to the joint line where the cord leads could be identified. I was able to identify by x-ray the lead that was heading down towards the superomedial genicular nerve and pulled that out through that incision from distal to proximal. A second incision was then made directly over the "arms" of the IPG taking care not to damage the insulation themselves and maintaining the subcutaneous pocket. The medial arm was verified to correspond to the broken lead by a gentle tug, and it was unscrewed and removed. Of course prior to this, we verified functioning of the lateral lead and malfunction of the medial as well. At this point, we verified that the lateral lead was still functioning. A distal incision was made directly over the medial epicondyle, and using a combination of palpation and fluoroscopy, I was able to isolate the distal tip of the broken medial lead. It was grabbed with a tonsil and removed in an antegrade fashion so as not to disrupt the tissues at all times with times. At this point, a new needle/trocar was used from the middle incision to the medial epicondyle, verified in position to correlate with standard positioning and the prior position of the previously successful lead and a new 40-cm tined lead was inserted through the trocar with good fixation, and the trocar of course was removed. I tunneled the proximal aspect of the lead up to the IPG arm and plugged it in and verified that this new medial lead was now functioning and torqued it into position. The final check of the entirety of the functioning device was performed and successful. At this point, all 3 incisions were thoroughly irrigated and closed carefully with buried and subcuticular suture, and sterile dressings were placed. The patient was awakened from anesthesia and brought to the recovery room in stable condition and without complication
POSTOPERATIVE DIAGNOSES: 1. Broken right superomedial genicular nerve peripheral neurostimulator lead.2. Right superomedial genicular nerve mononeuropathy.
OPERATIONS PERFORMED: 1. Revision right superomedial genicular nerve peripheral neurostimulator lead. 2. Implantation of peripheral neurostimulator lead, right superomedial genicular nerve.
Given his medical background and potential for longer procedure, a short-acting spinal was placed. The operative time-out was performed with all members of the operating room staff confirming patient, procedure, side, and site. Preoperative antibiotics were administered. The transverse incision was made over the initial insertion site about 10-15 cm proximal to the joint line where the cord leads could be identified. I was able to identify by x-ray the lead that was heading down towards the superomedial genicular nerve and pulled that out through that incision from distal to proximal. A second incision was then made directly over the "arms" of the IPG taking care not to damage the insulation themselves and maintaining the subcutaneous pocket. The medial arm was verified to correspond to the broken lead by a gentle tug, and it was unscrewed and removed. Of course prior to this, we verified functioning of the lateral lead and malfunction of the medial as well. At this point, we verified that the lateral lead was still functioning. A distal incision was made directly over the medial epicondyle, and using a combination of palpation and fluoroscopy, I was able to isolate the distal tip of the broken medial lead. It was grabbed with a tonsil and removed in an antegrade fashion so as not to disrupt the tissues at all times with times. At this point, a new needle/trocar was used from the middle incision to the medial epicondyle, verified in position to correlate with standard positioning and the prior position of the previously successful lead and a new 40-cm tined lead was inserted through the trocar with good fixation, and the trocar of course was removed. I tunneled the proximal aspect of the lead up to the IPG arm and plugged it in and verified that this new medial lead was now functioning and torqued it into position. The final check of the entirety of the functioning device was performed and successful. At this point, all 3 incisions were thoroughly irrigated and closed carefully with buried and subcuticular suture, and sterile dressings were placed. The patient was awakened from anesthesia and brought to the recovery room in stable condition and without complication