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An intraoperative electronic analysis of an implanted gastric neurostimulator pulse generator and transmitter system is conducted to ensure the proper functioning of the device. This procedure is essential for patients suffering from gastroparesis, a condition that results in delayed gastric emptying, leading to various digestive issues. Gastric electrical stimulation (GES) is a therapeutic approach that employs a gastric pacemaker device to deliver mild electrical stimulation to the lower stomach nerves. This stimulation promotes the contraction of the stomach muscles, facilitating the movement of food through the digestive tract. During the procedure, the gastric neurostimulator system is thoroughly evaluated, particularly during the separately reportable placement or replacement of the device. The neurostimulator and its memory card are programmed with specific parameters tailored to the patient's needs before the electrodes are inserted into the stomach. Following the placement of the electrode wires, an interrogation procedure is performed to assess the system's functionality. This involves checking the impedance between the wires and making necessary adjustments to ensure that the readings fall within the acceptable range. The procedure is comprehensive, including multiple checks and adjustments to confirm that the device operates correctly before the surgical incisions are closed. Once the impedance is confirmed to be within range, the stimulation settings are programmed and verified, ensuring that all components of the neurostimulator are functioning optimally before the device is activated.
© Copyright 2025 Coding Ahead. All rights reserved.
The electronic analysis of an implanted gastric neurostimulator pulse generator and transmitter system is indicated for patients diagnosed with gastroparesis, a condition characterized by delayed gastric emptying. This procedure is performed to ensure the proper functioning of the gastric electrical stimulation (GES) system, which is utilized to alleviate symptoms associated with this digestive disorder.
The procedure begins with the programming of the neurostimulator device and its memory card with patient-specific criteria prior to the insertion of the electrodes into the stomach. Following this, the electrode wires are placed, and an interrogation procedure is initiated. The interrogating head is attached and placed in a plastic bag to maintain sterility. The stimulating wires are then connected to the neurostimulator, and the impedance between the wires is checked. If the impedance readings are found to be out of range, the interrogation procedure is repeated. This may involve switching the polarity of the electrodes, removing and reinserting the wires into the stimulator, or even removing and replacing the wires in the stomach until the impedance is within the acceptable range. After the initial interrogation, the surgeon proceeds to complete the separately reportable implantation procedure. Upon finishing the implantation, the interrogation procedure and impedance analysis are conducted again, with similar steps taken to ensure that the impedance is within range. Once the impedance is confirmed to be acceptable, the incisions are closed, and the interrogation procedure is repeated once more. When the correct impedance range is achieved, the stimulation settings, including stimulation rate, pulse width, cycling times, and stimulating electrode settings, are programmed and reviewed. The battery status is also checked and recorded. After verifying the proper functioning of all components, the device is activated, and the interrogating head is removed.
After the procedure, the patient is monitored to ensure that the gastric neurostimulator is functioning correctly. Subsequent electronic analysis of the implanted neurostimulator device is typically performed at six-month intervals to verify the ongoing functionality of the GES system. During these follow-up analyses, the interrogating head is placed over the subcutaneous stimulator in the abdomen, and various parameters such as impedance, voltage, current, stimulation rate, pulse width, cycling times, stimulating electrode selections, and battery status are measured. These measurements are compared with previous settings to ensure consistency, although no adjustments may be necessary. If reprogramming is required, it is reported using CPT® code 98982, and the physician will perform the necessary adjustments and verify the results using the interrogator.
| Short Descr | IO ANAL GAST N-STIM INIT | Medium Descr | ELEC ALYS NSTIM PLS GEN GASTRIC INTRAOP W/PRGRMG | Long Descr | Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements) gastric neurostimulator pulse generator/transmitter; intraoperative, with programming | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | 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) | 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 | Items and Services Packaged into APC Rates | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 7 - Other diagnostic nervous system procedures |
| 59 | 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. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GZ | Item or service expected to be denied as not reasonable and necessary |
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| 2008-01-01 | Added | First appearance in code book in 2008. |
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