CPT® Code 0587T

Official Description

Percutaneous implantation or replacement of integrated single device neurostimulation system for bladder dysfunction including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve

Common Language Description

The CPT® Code 0587T refers to the procedure of percutaneous implantation or replacement of an integrated single device neurostimulation system specifically designed for bladder dysfunction. This procedure includes the implantation of an electrode array and a receiver or pulse generator, which are essential components of the neurostimulation system. The primary aim of this intervention is to address conditions such as overactive bladder (OAB), a chronic medical issue characterized by an increased urgency to urinate, frequent urination, and involuntary loss of urine, known as incontinence. The neurostimulation system works by delivering electrical signals to the posterior tibial nerve, which plays a crucial role in the bladder's function. These electrical impulses help to modify the communication between the sympathetic and parasympathetic nervous systems, thereby improving bladder storage capacity and reducing the frequency and urgency of urination. The device comprises an implanted lead or electrode, an external pulse transmitter that is worn over the electrode, and a handheld wireless remote control that allows for programming and adjustment of the stimulation settings by a qualified healthcare professional. The implantation procedure is performed under local anesthesia, involving a small incision or injection near the tibial neurovascular bundle, typically located just above the ankle. To ensure accurate placement of the lead or electrode, imaging guidance such as ultrasound may be utilized. This comprehensive approach not only facilitates the effective management of bladder dysfunction but also allows for subsequent adjustments and programming of the device to optimize patient outcomes.

1. Indications

The procedure described by CPT® Code 0587T is indicated for the treatment of bladder dysfunction, particularly in patients suffering from overactive bladder (OAB). OAB is characterized by symptoms such as:

Urgency: A sudden, compelling need to urinate that is difficult to defer.
Frequency: Increased urination frequency, often requiring multiple trips to the restroom throughout the day and night.
Incontinence: Involuntary loss of urine, which can lead to social embarrassment and impact the quality of life.

2. Procedure

The procedure for the implantation or replacement of the neurostimulation system involves several key steps:

Step 1: The patient is prepared for the procedure, which is performed under local anesthesia to minimize discomfort. The area above the ankle, where the tibial neurovascular bundle is located, is cleaned and sterilized.
Step 2: A small incision is made, or an injection is performed to introduce the lead or electrode into the appropriate location near the tibial neurovascular bundle. If the injection method is chosen, imaging guidance, such as ultrasound, may be utilized to ensure accurate placement of the electrode.
Step 3: Once the lead/electrode is correctly positioned, the external pulse transmitter is placed over the implanted lead/electrode. This transmitter is responsible for delivering electrical stimulation to the posterior tibial nerve.
Step 4: The physician then analyzes and programs the pulse transmitter and the handheld remote control to establish the appropriate stimulation settings tailored to the patient's needs.
Step 5: In cases where revision or removal of the device is necessary, a small incision is made over the implanted electrode, allowing for repositioning or complete removal of the lead. Ultrasound or active stimulation guidance may again be employed to ensure proper placement during this process, followed by reprogramming of the transmitter and remote device.

3. Post-Procedure

After the procedure, patients may experience some discomfort at the incision site, which typically resolves over time. Follow-up appointments are essential for monitoring the effectiveness of the neurostimulation system and making any necessary adjustments to the stimulation settings. Patients are advised to report any unusual symptoms or complications to their healthcare provider promptly. The overall recovery period may vary depending on individual circumstances, but most patients can resume normal activities relatively quickly, with specific instructions provided by their physician regarding post-procedure care and activity restrictions.

Short Descr	PERQ IMPLTJ/RPLCMT ISDNS PTN
Medium Descr	PERQ IMPLTJ/RPLCMT ISDNS BLDR DYSF PTN
Long Descr	Percutaneous implantation or replacement of integrated single device neurostimulation system for bladder dysfunction including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve
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)	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	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