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The procedure is done in office. My understanding is one kit includes one lead, but if an additional lead is needed to be used, then a second box with just the one lead is opened. I asked the rep for the product about this and he's telling me that we should bill 64561 twice with mod 59 attached to second procedure. But if only the second lead is used wouldn't it be proper to bill 64561 and then the A4290 for the second lead or should we still bill for 64561-59 with A4290? Thanks!!!