CPT® Code 0786T

1. Indications

The insertion or replacement of a percutaneous electrode array with an integrated neurostimulator is indicated for the following conditions:

• Urinary Incontinence - This procedure is performed to alleviate symptoms associated with urinary incontinence, which can significantly impact a patient's quality of life.
• Fecal Incontinence - It is also indicated for patients experiencing fecal incontinence, providing a means to improve bowel control.
• Bladder Dysfunction - The procedure may be indicated for individuals with bladder dysfunction, aiming to enhance bladder function and control.
• Bowel Dysfunction - It can assist in managing bowel dysfunction, contributing to better overall gastrointestinal health.

2. Procedure

The procedure begins with the patient positioned in a prone position, allowing access to the lower back and upper buttock area. The skin in this region is prepped to maintain a sterile environment. Under fluoroscopic guidance, the physician identifies the spinal midline and the level of the sacral foramen, typically at the S3 level. An insulated foramen needle is then inserted at an angle of approximately 60 degrees relative to the skin surface, with the needle being placed on either side of the midline. The depth and location of the needle are carefully verified to ensure accurate placement. Once the needle is positioned correctly, neurostimulation is performed to confirm the correct placement of the electrode array. This is assessed by observing contractions or tingling sensations in the pelvic floor muscles and plantar flexion of the great toe. Notably, stimulation at the S2 level will result in plantar flexion and lateral rotation of the entire foot, along with contraction of the levator muscles, while S4 positioning will yield no lower extremity response, only pelvic floor contraction or tingling. After confirming the correct needle position, lead wires are passed through the needles, which are then removed cautiously to prevent dislodging the leads. If a temporary connector was utilized during trial implantation, the incision in the upper buttock is either reopened or a new incision is created to place the permanent implantable pulse generator (IPG) in a subcutaneous pocket. The leads are then tunneled through the subcutaneous fat, connected to the IPG, and secured within the subcutaneous pocket. Following this, retesting is conducted to ensure proper placement of the IPG and leads, which are then secured in position before the pocket is sutured closed. In cases where replacement is necessary, the existing device is removed, and the new device is implanted following the same procedural steps, typically due to malfunction, device breakdown, or the depletion of battery life.

3. Post-Procedure

After the procedure, patients are monitored for any immediate complications and to ensure the proper functioning of the implanted device. Post-procedure care may include instructions on activity restrictions, wound care, and signs of potential complications such as infection or device malfunction. Patients are typically advised to avoid strenuous activities for a specified period to allow for proper healing. Follow-up appointments are essential to assess the effectiveness of the neurostimulation and to make any necessary adjustments to the device settings. The expected recovery time may vary depending on individual circumstances, but patients can generally expect to resume normal activities within a few weeks, contingent upon their specific recovery progress and the physician's recommendations.