CPT® Code 0784T

Official Description

Insertion or replacement of percutaneous electrode array, spinal, with integrated neurostimulator, including imaging guidance, when performed

Common Language Description

The procedure described by CPT® Code 0784T involves the insertion or replacement of a percutaneous electrode array that is specifically designed for spinal applications. This device is equipped with an integrated neurostimulator, which is a sophisticated tool that enables patients to manage their pain by delivering low-level electrical impulses directly to the spinal cord. The use of a handheld remote control allows patients to adjust the stimulation as needed, providing a non-invasive option for alleviating intractable back and/or leg pain. The insertion of this device follows a successful trial placement of a percutaneous spinal stimulator electrode array, ensuring that the patient has responded positively to the initial stimulation before proceeding with the permanent implantation. The procedure typically begins with the creation of a small incision in the lower back, near the buttocks, or in some cases, the abdomen. This incision allows for the formation of a subcutaneous pocket where the neurostimulator generator will be placed. Imaging guidance, specifically fluoroscopy, is utilized during the procedure to accurately position the electrode array into the epidural space, which is the area between the spinal cord and the vertebrae. The correct placement is confirmed by testing for impedance and the presence of paresthesia, a tingling sensation that indicates the stimulation is effectively replacing the perception of pain. Once the optimal position is achieved, the neurostimulator generator is secured in the pocket and sutured into place, followed by irrigation and layered closure of the wound. In cases where the device needs to be replaced, the procedure is performed similarly, starting with the removal of the existing device, which may be necessary due to malfunction, breakdown, or depletion of battery life.

1. Indications

The procedure associated with CPT® Code 0784T is indicated for patients experiencing intractable back and/or leg pain that has not responded to conservative treatment options. The use of a percutaneous spinal electrode array with an integrated neurostimulator is particularly beneficial for individuals who have undergone a successful trial placement of a spinal stimulator and have demonstrated a positive response to electrical stimulation therapy.

Intractable Back Pain Patients suffering from chronic back pain that is resistant to standard pain management therapies.
Intractable Leg Pain Individuals experiencing persistent leg pain that has not improved with conservative treatments.
Successful Trial Placement Patients who have undergone a trial placement of a percutaneous spinal stimulator electrode array and have shown favorable results.

2. Procedure

The procedure for the insertion or replacement of the percutaneous electrode array involves several critical steps to ensure proper placement and functionality of the device.

Step 1: Incision and Pocket Formation The procedure begins with the creation of a small incision in the lower back, typically near the buttocks, or in some cases, the abdomen. This incision allows the surgeon to form a subcutaneous pocket where the neurostimulator generator will be placed. Care is taken to minimize tissue damage and ensure a clean surgical field.
Step 2: Imaging Guidance Fluoroscopy is employed to provide real-time imaging during the procedure. This imaging guidance is crucial for accurately positioning the electrode array into the epidural space, which is the area located between the spinal cord and the vertebrae. The use of fluoroscopy enhances the precision of the placement, reducing the risk of complications.
Step 3: Electrode Array Placement The electrode array is carefully inserted through the same access site into the epidural space. Once in place, the electrodes are tested for impedance and paresthesia. The presence of paresthesia indicates that the stimulation is effectively replacing the perception of pain, which is a key indicator of correct positioning.
Step 4: Generator Placement After confirming the optimal position of the electrode array, the neurostimulator generator is connected to the electrodes and placed into the previously formed subcutaneous pocket. The generator is then secured in place and sutured to prevent movement.
Step 5: Wound Closure The surgical site is irrigated to reduce the risk of infection, and the incision is closed in layers to promote proper healing. This layered closure technique helps to ensure that the skin and underlying tissues are adequately supported during the recovery process.
Step 6: Replacement Procedure If a replacement of the existing device is necessary, the procedure is performed similarly. The existing device is first removed, and then the new electrode array and neurostimulator generator are implanted following the same steps outlined above. Replacement may be indicated due to device malfunction, breakdown, or the end of battery life.

3. Post-Procedure

Post-procedure care involves monitoring the surgical site for signs of infection and ensuring that the patient understands how to operate the neurostimulator device. Patients are typically advised on activity restrictions and pain management strategies during the initial recovery period. Follow-up appointments are essential to assess the effectiveness of the neurostimulator and make any necessary adjustments to the stimulation settings. Additionally, patients should be educated on the signs of potential complications, such as unusual pain or changes in sensation, and instructed to report these to their healthcare provider promptly.

Short Descr	INS/RPLMT ELTRD RA SPI NSTIM
Medium Descr	INSJ/RPLCMT PERQ ELTRD RA SPI W/INTEGRATED NSTIM
Long Descr	Insertion or replacement of percutaneous electrode array, spinal, with integrated neurostimulator, including imaging guidance, when performed
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard 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
ASC Payment Indicator	Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Berenson-Eggers TOS (BETOS)	none
MUE	1

Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.

This service has been performed in part by a resident under the direction of a teaching physician