Clinical Context
A 58-year-old patient with chronic, refractory neuropathic pain (for example, failed back surgery syndrome or complex regional pain syndrome) presents after unsuccessful conservative management including medications, physical therapy, and epidural steroid injections. The treatment team elects implantation of an implantable neurostimulator generator system with closed feedback loop leads and a rechargeable battery and charging system to deliver spinal cord stimulation or dorsal root ganglion stimulation.
Pre-procedure workflow: the patient completes preoperative evaluation, informed consent, device trial (percutaneous leads connected to an external trial stimulator), and optimization of stimulation parameters. After a successful trial demonstrating significant pain reduction and functional improvement, the patient is scheduled for implantation of the permanent neurostimulator generator system.
Procedure workflow: in an operating room or ambulatory surgery center under monitored anesthesia care or general anesthesia, the implanting physician places implantable leads (or confirms prior lead positions), creates a generator pocket (typically in the buttock or abdominal subcutaneous tissue), connects and tunnels leads to the generator, implants the C1826 generator (rechargeable with charging system and closed-loop capability), tests system functionality intraoperatively, and closes incisions. Device programming and patient education on recharging and remote controls occur prior to discharge.
Typical site of service: inpatient hospital operating room or ambulatory surgery center depending on patient comorbidities and facility preference.
Common patient modifiers and administrative considerations: billing may require facility and professional components to be billed appropriately; applicable modifiers could document significant procedural services, reduced services, bilateral procedures, return to the operating room, or anesthesia-related modifiers as appropriate for payer adjudication.