laurenwilcox10
New
Appreciate some help on verifying if I should use CPT 63685 or CPT 63688 for the following procedure done on a Spinal Cord Stimulator Revision. I am leaning towards CPT 63685.
PROCEDURE:
Removal of Internal Pulse Generator
Revision of Generator Pocket
Implantation Pulse Generator/Boston Sci Spectra with extension x2
Use of fluroscopy for radiographic guidance
Interpretation of radiographic pictures
Op Description: The patient was brought to the operating room and was placed in the prone position. The patient's skin was prepped and drapped from the midthoracic through mid gluteal region. The region of previously implanted stimulator leads and generator were identified and marks were made over the previous incisions with the use of fluroscopic guidance. The skin was anesthetized with a combination of 1% lidocaine with eip, 0.25% marcaine and 8.4% bicard. This previous incision was opened using blunt and sharp dissection. Then the capsule surrounding the internal pulse generator was identifed and opened. The generator was dissected out and retention suture was removed. The St. Jude pulse generator was then removed from the pocket and removed in its entirety. The previous leads were disconnected from the generator. A testing cable was then connected to the previously implanted leads. The patient was woken from his sedation and had on the table testing using the Boston Scientific observational mechanical gateway system. The patient did receive adequate paresthesias in the lower extremity. The patient stated that the stimulation was much better than his previous generator and there was better coverage in his pain pattern. The patient then elected to have his generator changed to the new Boston scientific precision spectre a internal pulse generator. The previous generator pocket was then revised in order to accommodate the new generator along with tge use of a 2 extension sets. The previous leads were connected to a 25 centimeters extensions x2. The new generator was interrogated. All of the connections were verified and impedances were checked. A 2-0 ethibond retention suture was used to stabilize the new internal pulse generator within the modified pocket. The pocket was then washed out with a generous amount of solution containing of cefazolin. The deep and subcutaneous tissue was then closed with 3-0 vicryl sutures and the skin incisions were closed with 4.0 monocyl subcuticular sutures. Steri-strips and sterile dressings were applied. All instrument and sponge counts were correct. The patient was taken to recovery in stable condition. The patient received 2gm of cefazolin prior to incision.
PROCEDURE:
Removal of Internal Pulse Generator
Revision of Generator Pocket
Implantation Pulse Generator/Boston Sci Spectra with extension x2
Use of fluroscopy for radiographic guidance
Interpretation of radiographic pictures
Op Description: The patient was brought to the operating room and was placed in the prone position. The patient's skin was prepped and drapped from the midthoracic through mid gluteal region. The region of previously implanted stimulator leads and generator were identified and marks were made over the previous incisions with the use of fluroscopic guidance. The skin was anesthetized with a combination of 1% lidocaine with eip, 0.25% marcaine and 8.4% bicard. This previous incision was opened using blunt and sharp dissection. Then the capsule surrounding the internal pulse generator was identifed and opened. The generator was dissected out and retention suture was removed. The St. Jude pulse generator was then removed from the pocket and removed in its entirety. The previous leads were disconnected from the generator. A testing cable was then connected to the previously implanted leads. The patient was woken from his sedation and had on the table testing using the Boston Scientific observational mechanical gateway system. The patient did receive adequate paresthesias in the lower extremity. The patient stated that the stimulation was much better than his previous generator and there was better coverage in his pain pattern. The patient then elected to have his generator changed to the new Boston scientific precision spectre a internal pulse generator. The previous generator pocket was then revised in order to accommodate the new generator along with tge use of a 2 extension sets. The previous leads were connected to a 25 centimeters extensions x2. The new generator was interrogated. All of the connections were verified and impedances were checked. A 2-0 ethibond retention suture was used to stabilize the new internal pulse generator within the modified pocket. The pocket was then washed out with a generous amount of solution containing of cefazolin. The deep and subcutaneous tissue was then closed with 3-0 vicryl sutures and the skin incisions were closed with 4.0 monocyl subcuticular sutures. Steri-strips and sterile dressings were applied. All instrument and sponge counts were correct. The patient was taken to recovery in stable condition. The patient received 2gm of cefazolin prior to incision.