CPT® Code 0817T

Official Description

Open insertion or replacement of integrated neurostimulation system for bladder dysfunction including electrode(s) (eg, array or leadless), and pulse generator or receiver, including analysis, programming, and imaging guidance, when performed, posterior tibial nerve; subfascial

Common Language Description

The procedure described by CPT® Code 0817T involves the open insertion or replacement of an integrated neurostimulation system specifically designed for bladder dysfunction. This system includes electrodes, which may be in the form of an array or leadless configuration, as well as a pulse generator or receiver. The procedure is performed on the posterior tibial nerve, which is a branch of the sciatic nerve located in the lower leg. The stimulation of this nerve is intended to provide retrograde neuromodulation to the sacral nerve plexus, which plays a crucial role in controlling the lower urinary tract and bladder function. This treatment is particularly indicated for patients suffering from conditions such as overactive bladder or intractable urge incontinence. The procedure is performed with the patient in a suitable position, and the surgical site is prepared accordingly. The neurostimulator device is carefully placed in proximity to the posterior tibial nerve and secured in place, ensuring that it can effectively deliver the necessary electrical stimulation to alleviate bladder dysfunction. The entire process includes not only the surgical insertion but also the analysis, programming, and any imaging guidance that may be required during the procedure.

1. Indications

The procedure described by CPT® Code 0817T is indicated for the treatment of specific bladder dysfunctions. The following conditions are explicitly mentioned as suitable for this procedure:

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 for the open insertion or replacement of the integrated neurostimulation system involves several detailed steps:

Step 1: Preparation The patient is positioned appropriately, and the leg is prepped for surgery. The surgical site is marked to indicate the location of the posterior tibial nerve and the intended position for the neurostimulator device.
Step 2: Incision An incision approximately 3 cm superior and 2 cm posterior to the medial malleolus is made. This incision allows access to the underlying tissues.
Step 3: Dissection The dissection is carried down to the subfascial plane, where the tibial neurovascular bundle is identified. This bundle includes the posterior tibial nerve, which is the target for the neurostimulator.
Step 4: Device Placement The neurostimulator device is placed near the posterior tibial nerve. It consists of a battery-less cylinder with four small fixation wings, which help secure it to the fascia using non-absorbable sutures.
Step 5: Testing After placement, testing is conducted using an external control unit or transmitter. The motor response is observed to ensure proper placement and function of the device.
Step 6: Programming The device is programmed for the appropriate pulse width, frequency, and amplitude. The minimum amplitude is set at the level where the patient first experiences stimulation sensation, while the maximum amplitude is adjusted to the highest tolerable level for the patient.
Step 7: Post-Procedure Care A pressure bandage is applied to the surgical site to manage any potential bleeding and support healing. The patient is instructed on the use of the rechargeable transmitter, which they will use several times a week for a prescribed duration to provide the necessary treatment stimulation.

3. Post-Procedure

Post-procedure care involves monitoring the surgical site for any signs of infection or complications. The patient is advised to follow specific instructions regarding the use of the rechargeable transmitter, which is essential for delivering the treatment stimulation. Regular follow-up appointments may be necessary to assess the effectiveness of the neurostimulator and make any required adjustments to the programming. Patients should also be informed about potential side effects and the importance of adhering to the prescribed stimulation schedule to achieve optimal results in managing their bladder dysfunction.

Short Descr	OPN INSJ/RPLCMT INS PTN SUBF
Medium Descr	OPEN INSJ/RPLCMT INTEGRATED NSTIMJ SYS PTN SUBF
Long Descr	Open insertion or replacement of integrated neurostimulation system for bladder dysfunction including electrode(s) (eg, array or leadless), and pulse generator or receiver, including analysis, programming, and imaging guidance, when performed, posterior tibial nerve; subfascial
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

GC	This service has been performed in part by a resident under the direction of a teaching physician
LT	Left side (used to identify procedures performed on the left side of the body)