# 64590 or 65481 & 95971



## MELJNBBRB (Jan 16, 2015)

Hi list,
I am still learning Urology coding and I would like input on how others would code. I am wanting to code this as 64590/95971. Help me understand please 
TIA
Melissa Bedford,CCS,CPC




Procedures Perfromed:  
1.  InterStim Stage 2 - incision and subcutaneous implantation of sacral nerve neurostimulator (CPT 64590)
2.  Electronic analysis and programming (CPT 95971, 95972)


Surgeon: . 


Assistant: None 


Anesthesia: MAC, 1% Lidocaine with epi local 

Anesthesiologist: See operative record 


Indications:  is a 86 y.o. male 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. He was prepped and draped in the usual sterile fashion. 


Local injection of 1% Lidocaine with epinephrine was administered within the skin and subcutaneous tissues.  The skin overlying the previous left buttock pocket incision was opened using a 15 blade scalpel and the lead/percutaneous extension connection was identified and elevated out of the wound. The sutures holding the protective boot were cut and the protective boot was retracted. The set screws were exposed and loosened with the hex wrench. The boot was removed and discarded. The percutaneous extension was cut and also removed from the field. 


The subcutaneous pocket anterior to the muscle surface was enlarged using blunt dissection.  The pocket was copiously irrigated with GU irrigant (mixed with H2O).  Hemostasis was observed.  


At this point, the lead was inserted into the header of the InterStim neurostimulator until the blue tip was visualized at the distal window. A single set screw was tightened.  The neurostimulator was placed into the subcutaneous pocket with the attached identification side placed upwards and the excess lead wrapped underneath the neurostimulator. The programming head was placed over the implanted neurostimulator and a sterile cover to ensure adequate lead connection and the parameters were within normal limits. Impedances were confirmed to be within normal limits, greater than 50 and less than 4000.


The wound was closed in 2 layers with 3-0 Vicryl subcutaneous 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.


Final program settings:
Electrode configuration:  C1 (0- 3+), C2(1- 3+), C3(2- 0+), C4 (3- 0+), C5 (0-,1- 3+), C6 (1-,2- 3+), C7 (2-, 3- 0+)
Pulse width 210
Rate 14
Amplitute 2.2
Set at program C2


Estimate Blood Loss: min


Drains: None


Total IV Fluids: See anesthesia record. 


Specimens:  None


Complications: None 


Condition: Stable 


Disposition:  
Discharge to home.
Return to clinic in one day for programming and 2 weeks for postop.


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## pegasus623 (Jun 26, 2015)

it would be 64590.  There's some good information here. http://www.medtronicfeatures.com/wcm/groups/mdtcom_sg/@mdt/@neuro/documents/documents/sns-op-rep.pdf


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