# Help coding interstim procedure



## MELJNBBRB (Dec 8, 2014)

Hi list needing some guidance on how you all would code this. 
Would you code as 64581? 95971?

TIA,
Melissa Bedford,CCS,CPC


H/P:


Patient elects for stage I InterStim implantation.  I did discuss the procedure in detail as well as the risks, benefits and alternatives to the procedure with her.  She expressed understanding and would like to proceed as planned


Pre-operative Diagnosis: Overactive bladder with urge urinary incontinence


Post-operative Diagnosis: Same 


Procedures Perfromed: 
Incisional placement of sacral nerve stimulating lead 64571;  intraoperative
device program analysis, simple 95971; fluoroscopy 72000.


Surgeon: 


Assistant: None 


Anesthesia: MAC, 0.5% Marcaine local 

Anesthesiologist: See operative record 


Indications:   is a 75 y.o. female who has overactive bladder with urge urinary incontinence refractory to maximal medical management. 


Procedure Details:  
The patient was seen in the holding room. The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient concurred with the proposed plan, giving informed consent. The patient was taken to operating room, identified as  and the procedure verified. A Time Out was held and the above information confirmed. 


After adequate general anesthesia was achieved, the patient was placed in prone position.  Gel rolls were placed under the abdomen and chest.  Pillows were placed under the thighs and lower legs.   A ground pad was placed on the bottom of the patient's foot and the long test stimulator cable was connected to the ground pad and to the external stimulator.  She was prepped and draped in the usual sterile fashion. The C-arm was moved into the AP position to provide fluoroscopic mapping of the pelvis which included marking out the sciatic notches and the medial borders of the sacral foramina. 


The C-arm was then placed in the lateral position .  Local injection of 0.5% Marcaine was administered and a foramen needle was placed at a 60 degree angle into the left S3 foramen.  Live fluoroscopy was used to check the depth of the needle and to identify placement within the proper foramen.  Proper S3 needle placement was confirmed by the motor response of the Bellow's reflex and observation of plantar flexion of the great toe utilizing the external test stimulator and the j-hook and the patient cable.  


The foramen needle stylet was removed and a directional guide was placed and confirmed fluoroscopically. The foramen needle was removed. An incision was made peripherally to the directional guide through the skin and fascial layer. The lead introducer sheath with dilator was placed over the directional guide and directed into the foramen insuring the radiopaque marker of the lead introducer did not extend beyond the anterior edge of the sacrum. The dilator was unlocked and removed along with the directional guide. The lead was then placed through the introducer sheath to the 1st white line.  Position was checked fluoroscopically. The lead was then further introduced until 3 electrodes were visible below the sacrum. Each electrode was tested for location of visualization of motor responses. After satisfactory position was confirmed, the introducer sheath was retracted under continuous fluoroscopy, deploying the lead tines into the presacral tissue.  


An additional incision was made on the left buttock, just posterior to the iliac crest and lateral to the sacrum.  Blunt dissection was used to create a pocket within the subcutaneous tissues.  A tunneling tool with a straw was placed from the lead exit site subcutaneously to the incised pocket site. The tunneling tool was removed and the lead was fed through the straw and pulled out the pocket site. A protective boot was placed over the lead. The lead was inserted into the temporary percutaneous extension and the metal bands were aligned. The 4 set screws were tightened with the hex wrench. The bladder was pushed over the connection and 2-0 silk ties were sutured to the boot grooves on either side of the connection.


A tunnel was made subcutaneously and exited through a puncture site above the contralateral buttock. The percutaneous extension was placed through the straw and exposed the connected to the twist lock great cable.


The lead site was closed with interrupted 4-0 Monocryl suture. The buttock incision was closed in 2 layers with 3-0 Vicryl and 4-0 Monocryl subcuticular. Steri-Strips and sterile dressing was applied with Tegaderm.  


The patient was then awoken from anesthesia and transferred to PACU in stable condition.


Estimate Blood Loss: 5 mL


Drains: None


Total IV Fluids: See anesthesia record. 


Specimens:  None


Complications: None 


Condition: Stable 


Disposition:  
Discharge to home.
Obtain three-day bladder diary.
Return to clinic in one week for postop


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## 1formissy (Dec 12, 2014)

You are correct.


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