CPT® Code 64597 | Case2Code

Official Description

Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; each additional electrode array (List separately in addition to code for primary procedure)

Common Language Description

The procedure described by CPT® Code 64597 involves the insertion or replacement of a percutaneous electrode array that is part of a peripheral nerve neurostimulator system. This system is designed to alleviate intractable pain by delivering mild electrical impulses to disrupt the transmission of pain signals from the affected nerve to the brain. The neurostimulator and electrode array are approximately the size of a standard staple, making them minimally invasive and suitable for percutaneous placement. The procedure begins with the identification of the target nerve, followed by the administration of local anesthesia to ensure patient comfort. An introducer needle is then utilized to accurately position the integrated neurostimulator and electrode array adjacent to the nerve, often with the assistance of imaging guidance such as ultrasound. This imaging guidance is crucial for ensuring the precise placement of the device. Once the electrode array is in place, additional arrays may be inserted during the same session if necessary. The external pulse transmitter, which is worn externally over the electrode, is then activated to wirelessly stimulate the target nerve. The physician or qualified healthcare professional programs the pulse transmitter and the accompanying handheld remote control to deliver the appropriate stimulation settings tailored to the patient's needs. This comprehensive approach aims to provide effective pain management through advanced neurostimulation techniques.

1. Indications

The procedure associated with CPT® Code 64597 is indicated for patients experiencing intractable pain that has not responded to conventional treatments. The following conditions may warrant the use of this neurostimulator system:

Intractable Pain Patients suffering from chronic pain that is resistant to standard pain management therapies.
Peripheral Nerve Disorders Conditions affecting peripheral nerves that contribute to pain syndromes.
Neuropathic Pain Pain resulting from nerve damage or dysfunction, which may benefit from neurostimulation.

2. Procedure

The procedure for the insertion or replacement of the percutaneous electrode array involves several key steps to ensure successful implantation and functionality of the neurostimulator system:

Identification of Target Nerve The physician begins by identifying the specific peripheral nerve that is responsible for the patient's pain. This step is critical for ensuring that the neurostimulator will effectively disrupt the pain signals.
Administration of Local Anesthesia Once the target nerve is identified, local anesthesia is administered to the patient to minimize discomfort during the procedure. This ensures that the patient remains comfortable throughout the implantation process.
Placement of Introducer Needle An introducer needle is then carefully inserted to access the area adjacent to the target nerve. This step is performed with precision to ensure accurate placement of the neurostimulator and electrode array.
Use of Imaging Guidance Imaging guidance, such as ultrasound, is utilized during the procedure to visualize the target nerve and confirm the correct positioning of the electrode array. This enhances the accuracy of the placement and reduces the risk of complications.
Insertion of Integrated Neurostimulator and Electrode Array The integrated neurostimulator and electrode array are then inserted through the introducer needle and positioned adjacent to the target nerve. This step is crucial for the effective delivery of electrical impulses to disrupt pain signals.
Placement of External Pulse Transmitter After the electrode array is in place, an external pulse transmitter is positioned over the lead/electrode. This device is responsible for wirelessly stimulating the target nerve.
Programming of Stimulation Settings The physician or qualified healthcare professional then analyzes and programs the pulse transmitter and the handheld remote control to establish the appropriate stimulation settings tailored to the patient's specific pain management needs.

3. Post-Procedure

Following the procedure, patients may be monitored for any immediate complications or adverse reactions. It is essential to provide instructions regarding the care of the insertion site and any activity restrictions to promote healing. Patients will also receive guidance on how to use the external pulse transmitter and remote control for effective pain management. Follow-up appointments may be scheduled to assess the effectiveness of the neurostimulator and make any necessary adjustments to the stimulation settings.

Short Descr	INS/RPLCM PRQ ELTRD RA PN EA
Medium Descr	INSJ/RPLCMT PERQ ELTRD RA PN INT NSTIM EA ADD RA
Long Descr	Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; each additional electrode array (List separately in addition to code for primary procedure)
Status Code	Carriers Price the Code
Global Days	ZZZ - Code Related to Another Service
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)	1 - Statutory 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	Items and Services Packaged into APC Rates
ASC Payment Indicator	Packaged service/item; no separate payment made.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	1

This is an add-on code that must be used in conjunction with one of these primary codes.

64596

MPFS Status: Carrier Priced APC J1 ASC J8 Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; initial electrode array