Ask Dr. Z

Could you please clarify the changes in how codes 64561 and 64581 are used since the stipulation of temporary vs. permanent has been removed? Code 64561 is now described as including guidance and is percutaneous, and can be either temporary or permanent placement of electrode. Code 64581 is described as using an open approach, and it also can be temporary or permanent. My surgeons normally use a percutaneous approach to place a permanent tined lead through the S3 foramen, create a pocket and tunnel, attach an extension to the lead, and send the patient home for a trial period before they call the patient back for placement of the InterStim generator (64590). This sounds like 64561 to me because of the percutaneous approach and use of fluoro guidance. The type of lead and the fact that it is permanent seem irrelevant. They want to code 64581 because they are placing a permanent tined lead, and they have always used 64581 for stage 1.