Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), complex deep brain neurostimulator pulse
CPT4 code
Name of the Procedure:
Electronic Analysis of Implanted Neurostimulator Pulse Generator System (e.g., rate, pulse amplitude and duration, battery status, electrode selectability and polarity, impedance and patient compliance measurements), Complex Deep Brain Neurostimulator Pulse.
Summary
This procedure involves analyzing and adjusting an implanted neurostimulator (a device placed in the brain) used to manage neurological conditions. It checks various parameters like the rate and amplitude of the device’s pulses, battery status, and electrode function to ensure it's working correctly.
Purpose
The purpose of this procedure is to monitor and optimize the functioning of a deep brain neurostimulator. It addresses neurological conditions such as Parkinson's disease, dystonia, and essential tremor by ensuring the neurostimulator is effectively managing symptoms. The goal is to improve or maintain the patient's quality of life through precise adjustments.
Indications
- Parkinson's disease with motor fluctuations.
- Dystonia with disabling symptoms.
- Essential tremor that does not respond to medication.
- Other movement disorders managed by deep brain stimulation.
- Battery replacement or adjustment due to device alerts.
Preparation
- Patients may be advised to fast for a few hours before the procedure.
- Patients should inform their doctor about any medications they are taking.
- Baseline assessments of the patient's neurological condition may be conducted.
- Imaging tests, such as MRI or CT scans, may be required to confirm the position of the device.
Procedure Description
- The patient is positioned comfortably, usually in a sitting or reclining position.
- The external programmer communicates with the implanted neurostimulator wirelessly.
- Parameters like pulse rate, amplitude, duration, and impedance are checked and adjusted if necessary.
- Battery status and electrode functionality are assessed.
- Adjustments are made via a computer interface, which communicates changes to the neurostimulator.
- The patient's response to adjustments is monitored to ensure optimal settings.
- The patient may be asked to perform certain activities or movements to fine-tune settings.
Tools/Equipment:
- External programming device.
- Computer with specialized software.
- Wireless communication interface.
Anesthesia/Sedation:
- Local anesthesia for minor adjustments.
- General anesthesia is not typically required.
Duration
The procedure typically takes 30 minutes to an hour.
Setting
The procedure is usually performed in an outpatient clinic or a specialized neurological treatment center.
Personnel
- Neurologist or specialist in movement disorders.
- Trained nurse or medical technician.
- Occasionally, a neurosurgeon for complex adjustments.
Risks and Complications
- Infection at the device implantation site.
- Hardware malfunction or failure.
- Temporary increase in neurological symptoms.
- Allergic reactions to materials used in the neurostimulator.
Benefits
- Improved symptom control for movement disorders.
- Enhanced quality of life with fewer motor fluctuations.
- Non-invasive adjustments and monitoring.
- Immediate fine-tuning of neurostimulation settings for better outcomes.
Recovery
- Patients can usually go home shortly after the procedure.
- Normal activities can often be resumed the same day.
- Follow-up appointments may be scheduled to monitor progress and make additional adjustments.
Alternatives
- Medication adjustments without using neurostimulation.
- Surgical options for conditions not managed by medication or neurostimulation.
- Physical and occupational therapy.
Patient Experience
During the procedure, patients may feel brief sensations as adjustments are made. Discomfort is usually minimal. Post-procedure, some patients may experience temporary changes in symptoms as settings are fine-tuned. Pain management will be provided if needed, and comfort measures are taken to ensure patient ease.