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Vagus nerve blocking (VBLOC) therapy is a medical procedure designed to assist in the treatment of morbid obesity. The vagus nerve, also known as the pneumogastric nerve or cranial nerve X, originates from the brainstem and consists of two branches that extend along the esophagus, bronchi, and major blood vessels, passing through the diaphragm and terminating in the upper part of the stomach. This nerve plays a crucial role in the regulation of hunger and satiety by transmitting signals between the stomach, pancreas, and brain. In VBLOC therapy, an intermittent, high-frequency, low-energy electrical stimulus is applied to block these nerve impulses, thereby influencing the sensation of hunger and promoting weight loss. The procedure involves laparoscopic techniques for the revision or replacement of the vagal trunk neurostimulator electrode array, which includes connecting to an existing pulse generator. This minimally invasive approach allows for the adjustment or replacement of the electrode arrays that are strategically positioned around the vagus nerve trunks, facilitating effective management of obesity through neuromodulation.
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The vagus nerve blocking therapy is indicated for patients suffering from morbid obesity. This condition is characterized by an excessive amount of body fat that poses significant health risks, including but not limited to diabetes, hypertension, and cardiovascular diseases. The therapy aims to assist in weight management by altering the communication between the stomach and the brain, thereby reducing hunger signals and promoting a feeling of fullness.
The procedure for vagus nerve blocking therapy involves several critical steps to ensure the effective revision or replacement of the vagal trunk neurostimulator electrode array. Initially, the device is programmed off to prevent any unintended stimulation during the surgical process. A small portal incision is made in the upper abdomen, through which a trocar is inserted to facilitate access to the abdominal cavity. Following this, a pneumoperitoneum is established by insufflating carbon dioxide, creating a working space for the surgeon. Two to three additional small incisions are made to introduce the necessary surgical instruments for the procedure. A laparoscope is then introduced through a small incision just above the umbilicus, allowing for visualization of the surgical field. The liver is retracted to expose the previously implanted electrode arrays located at the anterior and posterior esophagogastric junction. If the procedure requires relocating the existing electrode arrays, one or both arrays are identified and repositioned around the vagus nerve trunks as necessary. In cases where replacement of the electrode arrays is needed, a skin incision is made over the neuroregulator, and the old leads are disconnected and removed. New leads are then placed, and if the neuroregulator itself requires replacement, it is extracted and a new device is implanted. The repositioned or newly placed leads are connected to the neuroregulator and tested to ensure proper function. If new leads have been installed, they are tunneled to the neuroregulator, connected, and tested again. Finally, the neuroregulator is returned to its subcutaneous pocket, which is subsequently closed with sutures. The neuroregulator is activated and programmed using a transmit coil and an external mobile charging unit, completing the procedure.
After the procedure, patients are typically monitored for any immediate complications related to the surgery. Expected recovery includes managing any discomfort at the incision sites and following specific post-operative care instructions provided by the healthcare team. Patients may be advised on activity restrictions and dietary modifications to support their recovery and weight management goals. The neuroregulator will be activated and programmed to ensure optimal functioning, and follow-up appointments will be scheduled to monitor the effectiveness of the therapy and make any necessary adjustments.
| Short Descr | LAPS RMVL NSTIM ARRAY VAGUS | Medium Descr | LAPS REVJ/REPLCMT NSTIM ELTRD ARRAY VAGUS NRV | Long Descr | Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator | Status Code | Carriers Price the Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | Not applicable/unspecified. | CCS Clinical Classification | 244 - Gastric bypass and volume reduction |
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| 2022-12-31 | Deleted | Code deleted. For laparoscopic implantation, revision, replacement, or removal of vagus nerve blocking neurostimulator electrode array and/or pulse generator at the esophagogastric junction, use 64999. |
| 2013-01-01 | Added | First appearance in codebook. |
| 2012-01-01 | Added | Added |
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