bhargavi
Guru
Procedures
Biventricular ICD Gen Change / downgrade biv icd to biv ppm
Pre-procedure Diagnosis
Encounter for adjustment and management of automatic implantable cardiac defibrillator [Z45.02]
Link to Procedure Log
Procedure Log
Indications
ICD (implantable cardioverter-defibrillator) battery depletion [Z45.02 (ICD-10-CM)]
Ischemic cardiomyopathy [I25.5 (ICD-10-CM)]
Chronic atrial fibrillation [I48.2 (ICD-10-CM)]
CHB (complete heart block) [I44.2 (ICD-10-CM)]
Chronic systolic CHF (congestive heart failure), NYHA class 2 [I50.22 (ICD-10-CM)]
Conclusion
BiV ICD Gen Change and Downgrade to BiV PPM
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Procedure(s): PG Replacement Downgrading from BiV ICD to BiV PPM
*
Indications:
BiV ICD ERI
CHB
Permanent Atrial Fibrillation
Ischemic cardiomyopathy
Chronic Systolic CHF FC II
Advanced Dementia
*
Hardware Implanted: ## Not MRI Compatible ##
Medtronic VIVA CRT-P MN C6TR01, SN PVZ608330S
*
Hardware Explanted:
Medtronic CRT-D Consulta MN D224TRK, SN PUD252320H
*
*
Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was marked and timeout done.
*
The antibiotic was completely infused. The patient was prepped and draped in the usual sterile fashion and the left upper chest anesthetized with 10 cc of 50/50 mixture of 0.25% marcaine and 2% lidocaine. An incision was made in the deltopectoral groove and electrocautery used to perform dissection down to the pacemaker pocket where the pocket was incised, the device delivered. Pacing and sensing parameters were tested. The old leads were secured to the new device and the device placed in the pocket after expanding the pocket, irrigation with an antibiotic solution, and hemostasis. The ICD shocking leads were capped and tied with 0-silk while the pacing electrode continues to be used.
*
The Incision was closed in 3 layers, the lower two with running 2-0 Vicryl and the cutaneous with 4-0 Vicryl. Steri-Strips and a dry sterile dressing were placed over the wound and the patient was transferred to the PACU in stable condition for recovery from anesthesia. The patient's underlying rhythm was CHB with atrial fibrillation. The atrial port continues to be plugged.
*
Measured Data: RV R wave dependent, 475 ohms, thr 1.0 V at 0.5 ms
LV 703 ohms, thr 1.0 V at 0.5 ms
*
Final Parameters: V00 70. Due to continuing to use Fidelis lead, and risk of Fidelis failure in the future in a pacer dependent patient who is bedbound and inactive, VOO was programmed as his safest option.
*
Anesthesia: MAC
*
Estimated Blood Loss: 2 cc
**
Complications: None
**
Condition: stable
the physician explanted ICD and implant BIV Pacemaker with existing leads so should I bill 33208 or 33213 for pacemaker along with 33241?
thanks in advance
Biventricular ICD Gen Change / downgrade biv icd to biv ppm
Pre-procedure Diagnosis
Encounter for adjustment and management of automatic implantable cardiac defibrillator [Z45.02]
Link to Procedure Log
Procedure Log
Indications
ICD (implantable cardioverter-defibrillator) battery depletion [Z45.02 (ICD-10-CM)]
Ischemic cardiomyopathy [I25.5 (ICD-10-CM)]
Chronic atrial fibrillation [I48.2 (ICD-10-CM)]
CHB (complete heart block) [I44.2 (ICD-10-CM)]
Chronic systolic CHF (congestive heart failure), NYHA class 2 [I50.22 (ICD-10-CM)]
Conclusion
BiV ICD Gen Change and Downgrade to BiV PPM
*
Procedure(s): PG Replacement Downgrading from BiV ICD to BiV PPM
*
Indications:
BiV ICD ERI
CHB
Permanent Atrial Fibrillation
Ischemic cardiomyopathy
Chronic Systolic CHF FC II
Advanced Dementia
*
Hardware Implanted: ## Not MRI Compatible ##
Medtronic VIVA CRT-P MN C6TR01, SN PVZ608330S
*
Hardware Explanted:
Medtronic CRT-D Consulta MN D224TRK, SN PUD252320H
*
*
Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was marked and timeout done.
*
The antibiotic was completely infused. The patient was prepped and draped in the usual sterile fashion and the left upper chest anesthetized with 10 cc of 50/50 mixture of 0.25% marcaine and 2% lidocaine. An incision was made in the deltopectoral groove and electrocautery used to perform dissection down to the pacemaker pocket where the pocket was incised, the device delivered. Pacing and sensing parameters were tested. The old leads were secured to the new device and the device placed in the pocket after expanding the pocket, irrigation with an antibiotic solution, and hemostasis. The ICD shocking leads were capped and tied with 0-silk while the pacing electrode continues to be used.
*
The Incision was closed in 3 layers, the lower two with running 2-0 Vicryl and the cutaneous with 4-0 Vicryl. Steri-Strips and a dry sterile dressing were placed over the wound and the patient was transferred to the PACU in stable condition for recovery from anesthesia. The patient's underlying rhythm was CHB with atrial fibrillation. The atrial port continues to be plugged.
*
Measured Data: RV R wave dependent, 475 ohms, thr 1.0 V at 0.5 ms
LV 703 ohms, thr 1.0 V at 0.5 ms
*
Final Parameters: V00 70. Due to continuing to use Fidelis lead, and risk of Fidelis failure in the future in a pacer dependent patient who is bedbound and inactive, VOO was programmed as his safest option.
*
Anesthesia: MAC
*
Estimated Blood Loss: 2 cc
**
Complications: None
**
Condition: stable
the physician explanted ICD and implant BIV Pacemaker with existing leads so should I bill 33208 or 33213 for pacemaker along with 33241?
thanks in advance