Hi, I could use some assistance with this procedure. I am unclear on the revision codes, they are confusing to me. If you have any thoughts, opinions, or written guidance, it would be appreciated.
I'm thinking
64561,RT
64585,LT
64595
Postoperative diagnosis: Post-op Diagnosis
* Urge incontinence of urine [N39.41]
Procedure(s) performed: Procedure: SACRAL NEUROMODULATION SYSTEM PERMANENT LEAD REVISION
Findings: Unable to locate S3 foramina bilaterally and final lead placed on right in S4 with good bellows
Brief history and indications for procedure:
Laura L Fox is a 64 y.o. female who is undergoing a sacral neuromodulation system lead revision because of inadequately improved symptoms following implant of sacral neuromodulation device, patient fall and subsequent malposition of lead. The risks, benefits, alternatives, and possible complications of the procedure were discussed at length with the patient. These include, but are not limited to, pain, bleeding, infection, injury to surrounding structures, failure to improve symptoms adequately and need for further procedures. The patient's questions were answered, and the patient expressed understanding of the above. A final decision for surgery was made, and informed consent was obtained. Appropriate preoperative medical evaluation and tests were performed as indicated.
Procedure:
The patient was identified in the preoperative holding area, informed consent was confirmed, and the patient had the opportunity to ask further questions if desired. The patient was then brought back to the operating room and appropriately positioned, prepped, and draped following administration of a General anesthetic. Appropriate lines and monitors were in place, and the patient had been secured to the table during positioning to ensure stability and safety. Availability of all required equipment and supplies was reviewed and confirmed prior to the induction of the anesthetic to the best of the ability of the entire operating crew, including me as the surgeon. A timeout was performed according to operating room protocol immediately before beginning the procedure.
Fluoroscopy was used to identify landmarks and the position of the electrode array and pulse generator both on the left side. The electrode array was noted to have turned medially. An incision was made over the site of the pulse generator and this was removed from the pocket over the left buttock. The electrode array was disconnected from the pulse generator and the pulse generator was set to the side. An incision was made over the site of the electrode array over the sacral foramina and removed through the incision with hemostats under fluoroscopic guidance.
Many attempts were made to locate the S3 sacral foramen bilaterally unsuccessfully. The S4 sacral foramen was cannulated with a foramen needle on the right side. The external generator was used to illicite the typical neuromotor responses of anal bellows. The tined lead was then inserted into the S4 foramen through the provided trocar. Again the device was tested with good response.
The tined lead was tunneled over from the ipsilateral side and the lead was then secured to the battery and locked into place with the provided screwdriver. The battery was then inserted into the pouch and it fit nicely. The battery was then interrogated with the external programmer. It registered with resistances in the normal range. The wound was then closed in two layers with 3-0 vicryl in the subcutaneous fat and 4-0 monocryl in the skin. The midline wound from the prior electrode removal was closed with 4-0 monocryl. All incisions were covered with skin glue.
I'm thinking
64561,RT
64585,LT
64595
Postoperative diagnosis: Post-op Diagnosis
* Urge incontinence of urine [N39.41]
Procedure(s) performed: Procedure: SACRAL NEUROMODULATION SYSTEM PERMANENT LEAD REVISION
Findings: Unable to locate S3 foramina bilaterally and final lead placed on right in S4 with good bellows
Brief history and indications for procedure:
Laura L Fox is a 64 y.o. female who is undergoing a sacral neuromodulation system lead revision because of inadequately improved symptoms following implant of sacral neuromodulation device, patient fall and subsequent malposition of lead. The risks, benefits, alternatives, and possible complications of the procedure were discussed at length with the patient. These include, but are not limited to, pain, bleeding, infection, injury to surrounding structures, failure to improve symptoms adequately and need for further procedures. The patient's questions were answered, and the patient expressed understanding of the above. A final decision for surgery was made, and informed consent was obtained. Appropriate preoperative medical evaluation and tests were performed as indicated.
Procedure:
The patient was identified in the preoperative holding area, informed consent was confirmed, and the patient had the opportunity to ask further questions if desired. The patient was then brought back to the operating room and appropriately positioned, prepped, and draped following administration of a General anesthetic. Appropriate lines and monitors were in place, and the patient had been secured to the table during positioning to ensure stability and safety. Availability of all required equipment and supplies was reviewed and confirmed prior to the induction of the anesthetic to the best of the ability of the entire operating crew, including me as the surgeon. A timeout was performed according to operating room protocol immediately before beginning the procedure.
Fluoroscopy was used to identify landmarks and the position of the electrode array and pulse generator both on the left side. The electrode array was noted to have turned medially. An incision was made over the site of the pulse generator and this was removed from the pocket over the left buttock. The electrode array was disconnected from the pulse generator and the pulse generator was set to the side. An incision was made over the site of the electrode array over the sacral foramina and removed through the incision with hemostats under fluoroscopic guidance.
Many attempts were made to locate the S3 sacral foramen bilaterally unsuccessfully. The S4 sacral foramen was cannulated with a foramen needle on the right side. The external generator was used to illicite the typical neuromotor responses of anal bellows. The tined lead was then inserted into the S4 foramen through the provided trocar. Again the device was tested with good response.
The tined lead was tunneled over from the ipsilateral side and the lead was then secured to the battery and locked into place with the provided screwdriver. The battery was then inserted into the pouch and it fit nicely. The battery was then interrogated with the external programmer. It registered with resistances in the normal range. The wound was then closed in two layers with 3-0 vicryl in the subcutaneous fat and 4-0 monocryl in the skin. The midline wound from the prior electrode removal was closed with 4-0 monocryl. All incisions were covered with skin glue.