# Removal of spinal cord stimulator



## pajohnson (Jan 31, 2014)

Hi All-
I am going back an forth between which code to use for the following removal:

DESCRIPTION OF PROCEDURE:  The patient was brought to the operating room
where general anesthesia was induced and an endotracheal tube was placed.
The patient's position in the lateral position, left side up.  Pressure
points were padded.  The patient was prepped and draped in a routine
fashion.  Skin was infiltrated with 0.5% Xylocaine with 1:200,000
epinephrine.  The incision on the abdomen where the battery had been
removed was opened.  The battery was removed and the wires were cut next to
the generator.  The thoracic incision was then opened.  The incision was
carried down through the skin and deeper dissection was done with the
cautery.  The click attachments had been placed and sewn along the muscular
fascia. This area was freed up and the exposure extended down along the
lamina to expose the laminotomy area which was medially.  The wires were
cut at the supraspinous area.  They could not be pulled from the abdominal
area.  That was dealt with later.  The wires were then followed down to the
laminotomy margin.  Amazingly bone at grown around the wire on the left
side.  This bone had to be removed with a Kerrison punch.  The laminotomy
area was opened slightly more with a Kerrison punch and a right angle
curette was used to free up the scar tissue until the epidural lead could
be freed up and removed.  There were a couple of the contact points which
were loose when this was pulled out.  AP fluoroscopy was used and there was
one additional portion down in the laminotomy area.  I explored that with a
long nerve hook and was able to free that up and remove it.  The
fluoroscopy after that showed no sign of abnormality in the laminotomy
area.  The wires were freed up extending a bit farther along the
supraspinous ligament.  There had been one mid portion incision over the
left flank and this was opened.  Ultimately the wires were identified and
with pulling this, the entire portion came out.  There had been extensions
placed on the wires which was the source of the catch.  The fluoroscopy
again was used and there was no hardware or wire of any type which could be
visualized.  Incision was then irrigated thoroughly with triple antibiotic
solution.  Incisions were closed in the back using 0 Vicryl sutures in the
muscular fascia and the deep subcutaneous fascia.  There paravertebral
muscles were infiltrated with a total of 30 mL of 0.25% Marcaine plain
anesthetic. The skin was closed with interrupted 3-0 Vicryl subcuticular
stitches and Steri-Strips. The reservoir incision and the other incisions
were closed with interrupted 0 Vicryl suture, in the subcutaneous fascia
with interrupted 3-0 Vicryl subcuticular stitches and Steri-Strips.
Estimated blood loss for the procedure was 75 mL.  Sponge and needle counts
were reported to be correct.  The patient was taken to the recovery room in
stable condition.

Is it 01936 or 00400?  Or am I wrong about both?  Could somebody please explain this removal process in detail.  Thanks


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## TJMiller (Jan 31, 2014)

I'm not great at neurosurgery to know excatly what was billed for the surgery, but since this was done with the fluroscopy I'd go with 01936.


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## pajohnson (Jan 31, 2014)

Thanks for the input.  I am confusing myself after reading the Op report so many times


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## dwaldman (Feb 1, 2014)

I would use 00620 this looks like a lead removal with open exposure under 63662 63688 with lead previously placed via laminotomy.

For percutaneous lead removal and IPG 63661 63688, I use 00300 because the of location is more in the trunk area.

Whereas, for pain pump removal I use 00400.


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## sriese (Aug 8, 2014)

for removal of DCS or spinal cord stimulator use codes 63661, 63688-51 this includes fluoroscopy.


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