# Occipital Nerve Stimulator



## lcole7465 (Mar 28, 2019)

The following procedure was performed by one of my pain docs... I'm stuck between coding this as 61885 or 64555 but leaning more towards 61885.

Procedure Performed: Placement of dual 8-electrode occipital stimulator for trial occipital stimulation.

Patient was placed in prone position, neck was slightly tucked, hair had been trimmed. The patients scalp and neck were prepped with betadine and sterilely draped. Bony landmarks were identified with fluoroscopy as well as palpitation.Beginning in the mid-line along with occipital ridge, after satisfactory local anesthesia, a curved 14-gauge Tuohy needle was advanced subcutaneously such as to lie along the occipital ridge in such a fashion to cover the tract of the greater and lesser occipital nerves bilaterally. Through this, starting on the left, an 8-electrode Boston Scientific lead was passed and the introducer needle was withdrawn. Fluoroscopy confirmed appropriate lead location. This exact technique was then repeated on the right side. Once lead position was satisfactory across the occipital ridge, the area was cleansed, anchoring devices placed over both leads and secured to the skin with nylon sutures.


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## dwaldman (Mar 31, 2019)

I would go with CPT 64555

AMA CPT Network
Question
What is the appropriate code to report if occipital nerve stimulation leads are placed under the skin near the great and lesser occipital nerves, and these leads are then attached to an implantable pulse generator that is also placed under the skin? 
Answer
Codes 64555, Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve), and 64590, Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling, should be reported. Because the great and lesser occipital nerves are peripheral nerves, it would not be appropriate to report either code 63650, Percutaneous implantation of neurostimulator electrode array, epidural, or 63685, Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling. 

AMA CPT Assistant January 2015
Surgery: Nervous System
Question: What is the appropriate code to report for neurostimulator implantation and placement of leads over a peripheral
nerve in the head for treatment of migraines?

Answer: It would be appropriate to report code 64555, Percutaneous implantation of neurostimulator electrode array; peripheral nerve (excludes sacral nerve), for the lead placement.
Insertion of the neurostimulator pulse generator would be reported with code 64590, Insertion or replacement of peripheral or gastric neurostimulator pulse generator
or receiver, direct or inductive coupling.


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