Ask Dr. Z

The people I work for will only listen to you. Would you code this as 64561 or 64581 for placement of an InterStim quadripolar lead? "Needle introduced 2 cm above sciatic notch and 2 cm lateral to sacral midline, feeling for foramenal margins. S3 foramen identified and penetrated. Depth of needle confirmed, adjusted with fluoro. Needle position confirmed by observation of bellows and plantar flexion. Needle stylet removed and directional guide placed, confirmed with fluoro. Needle removed. Incision made peripheral to directional guide thru fascia. Lead introducer sheath with dilator placed over directional guide into foramen ensuring radiopaque marker of introducer did not extend beyond anterior edge of sacrum. Dilator unlocked and removed with directional guide. Lead placed through introducer sheath to first white line. Position checked with fluoro. Lead further introduced until 3 electrodes visible below sacrum. Electrodes tested by observation of bellows and plantar flexion. Introducer sheath retracted under fluoro, deploying tines into perisacral tissue."