Wiki 64561 vs 64581 for Interstim lead placement

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jfolz

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My fellow coder and I have just discovered that we are sometimes coding Interstim lead placements differently and I am trying my hardest to make sure I am doing it correctly. I code for a surgery center that does both stage I Interstim lead placements and stage II lead placements.
The approach is the thing we are discussing, and it determines the CPT for Interstim lead placement. All of the physicians dictate that they make a small incision to insert the needle and then tunnel it to the nerve placement area. They never indicate a second incision in their dictation but they do place anchors to hold the leads in place when they are permanently placed at the correct level.
I am concerned that I am not doing this correctly.
My thinking is that "incisional" is direct access to the part you are working on and "percutaneous" can include a small incision but is not necessarily direct access to the location, IE tunneling to the final spinal placement from the small incision it takes to get the lead inside the body. Another discussion we had was that 64561 may be only for Stage I temporary placements but the CPT book indicates it can also be used for permanent lead placements.

Can anyone provide either a sample Op from an incisional Interstim lead placement 64581 and/ or a percutaneous lead placement 64561 so that I can see the difference between the wording on these approaches? Or point us to literature that definitively answers this?
Thanks for any guidance you may provide!
 
Thank you for your response!
The issue I'm having is I thought the same way until I saw the entry in the CPT book that states that CPT 64561 can be used for permanent lead placement. That's why I'm questioning everything again. I do feel that the approach that our physicians are using to place both the trial lead and later the permanent lead are percutanous entry to the body at the generator site to allow the leads to be tunneled to their final destination at the nerve. I could see coding 64581 if there was an incision made at the location of the nerve directly and then tunneling back to the generator pocket because that incision is allowing direct access to the body part we are working on.
Would you happen to have any sample op notes or literature specifically stating that 64561 is temporary only?
 
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