# 64595 OR 64590? tia



## MELJNBBRB (Mar 6, 2015)

Here is this from the HPI I am confused on whether to use 64595 or 64590, both codes are for replacement... arghhhh. Thanks
MB,CCS,CPC


Depleted battery

Plan:  



Options were reviewed with the patient
I made sure that she had realistic expectations and understood alternatives.  She does want to proceed with surgery.
Exchange battery plus/minus lead. 





PREOPERATIVE DIAGNOSIS(ES):
Malfunction of InterStim.

POSTOPERATIVE DIAGNOSIS(ES):
Malfunction of InterStim.

Surgeon: 

Assistant(s): none


ANESTHESIA:
Local lidocaine with monitored anesthesia care.

COMPLICATIONS:
None.


Specimens:
None


EBL:  miminal


INDICATIONS:  The patient has elected to proceed with Interstim revision.  Risks,  
Including lead fracture have been reviewed.


PROCEDURE(S)/OPERATION(S) PERFORMED:
1. Placement of sacral neurostimulator, 64590.
2. Removal of sacral neurostimulator, 64595.
3. Intraoperative device programming analysis, simple, 95971.


FINDINGS:
There were no complications.

SUMMARY:
The patient was carefully positioned in the prone position, prepped and
draped in a standard sterile manner with chlorhexidine, alcohol and
ChloraPrep. The skin incisions were marked with a marking pen. The skin
and subcutaneous tissue around the planned incisions were infiltrated with
1% lidocaine. Over the patient's existing stimulator pocket, the incision
was carried down to the level of the capsule. The patient's existing
stimulating unit was extracted. 




A new neurostimulator was then placed in the right buttocks pocket. The
device was interrogated.  The device was analyzed and programmed.  Impededance was normal.
All leads were operational.  Lead one selected.


Copious antibiotic irrigation had been utilized. The wounds
were closed in layers with 3-0 Biosyn, 4-0 Biosyn, and 4-0 Biosyn
subcuticular. Mastisol, Steri-Strips, Telfa, and Tegaderm were applied.
The patient tolerated this procedure well. All counts were correct.


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## JEYCPC (Mar 9, 2015)

Only the 64590 is for insertion or replacement.  64595 is for a revision or removal. 

I noticed in the Coder's Desk Reference for Procedures 2015 That 64590 states "the physician creates a pocket" verses 64595 states " The placement incision is reopened"

I hope this helps.

Jane Young, CPC


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## emcee101 (Mar 11, 2015)

For me it comes down to the words used in the two codes. 64590 states insertion or replacement. 64595 states revision or removal. To me the op note is clear that a replacement was performed since one device was removed and another placed. 64590 would be my code choice.


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## MELJNBBRB (Mar 11, 2015)

Thanks so much!!!


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