CPT® Code 0816T

1. Indications

The procedure is indicated for the treatment of specific bladder dysfunctions, particularly:

• Overactive Bladder A condition characterized by an urgent need to urinate frequently, often accompanied by incontinence.
• Intractable Urge Incontinence A type of urinary incontinence that is difficult to manage and is characterized by a sudden, intense urge to urinate, leading to involuntary loss of urine.

2. Procedure

The procedure involves several critical steps to ensure the successful insertion of the neurostimulation system:

• Step 1: Preparation The patient’s leg is prepped and positioned appropriately to allow for optimal access to the posterior tibial nerve. This includes cleaning the area to minimize the risk of infection.
• Step 2: Identification of Landmarks The surgeon identifies anatomical landmarks and takes precise measurements to locate the posterior tibial nerve and determine the intended position for the neurostimulator device.
• Step 3: Incision and Dissection An incision is made over the marked site, and the subcutaneous tissues are carefully dissected approximately 3 cm superior and 2 cm posterior to the medial malleolus to access the nerve.
• Step 4: Creation of Subcutaneous Pocket A subcutaneous pocket is created to accommodate the battery-less neurostimulator cylinder, which features four small fixation wings that include a receiver and two bipolar electrodes.
• Step 5: Device Placement The neurostimulator device is placed within the created pocket and positioned correctly to ensure effective stimulation of the posterior tibial nerve.
• Step 6: Testing and Programming The device is tested using an external control unit, and programming is performed to set the appropriate pulse width, frequency, and amplitude for optimal therapeutic effect.
• Step 7: Closure Sutures are placed to secure the device in position, and the incision is closed to complete the procedure.

3. Post-Procedure

After the procedure, the patient is expected to use a rechargeable transmitter several times a week for a prescribed duration to provide the necessary treatment stimulation. Post-procedure care may include monitoring for any signs of infection at the incision site, managing pain, and ensuring the proper functioning of the neurostimulator device. Follow-up appointments may be scheduled to assess the effectiveness of the treatment and make any necessary adjustments to the device settings.