bhargavi
Guru
Procedures
Biventricular Icd Gen Change w/ new rv lead
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)]
Cardiomyopathy, dilated, nonischemic [I42.9 (ICD-10-CM)]
Chronic systolic CHF (congestive heart failure), NYHA class 2 [I50.22 (ICD-10-CM)]
Left bundle branch block [I44.7 (ICD-10-CM)]
Ventricular tachycardia [I47.2 (ICD-10-CM)]
Presence of manufacturer-recalled ICD lead, initial encounter [T82.198A (ICD-10-CM)]
Conclusion
Cardiac BiV ICD Pulse Generator Replacement and new RV Lead Operative R
*
Procedure(s): BiV ICD Pulse Generator Replacement
New RV ICD lead
Intra-operative ICD and DFT testing once successfully at 15 j
*
Indications:
ICD ERI
VT
LBBB
Chronic systolic chf FC II
Nonischemic dilated cardiomomyopathy
SSS
Fidelis RV Lead on Recall
*
Hardware Implanted: ## NOT MRI COMPATIBLE DUE TO ABANDONED LEAD ##
Medtronic CLARIA MRI MN DTMA1D4, SN RPC200983H
Medtronic RV ICD lead MN 6935M-62, SN TDL264579V
*
Hardware Explanted:
Medtronic BiV ICD MN D314TRG, SN PRS220191H
*
Hardware Abandoned, cut and capped:
Fidelis Medtronic RV ICD lead MN 6949-65, SN LFJ043962V
*
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 device pocket where the pocket was incised, device delivered, and the leads tested. A single left axillary vein puncture placed a guidewire into the superior vena cava. A tear-away sheath introduced the lead into the superior vena cava where fluoroscopic guidance assisted placement of the active fixation right ventricular lead into the RV apex and then lifted into the distal RV septum where the lead was actively fixated. The lead was anchored to the pectoralis fascial using 0 Ethibond. Pacing and sensing thresholds were obtained. The new RV lead was secured to the device along with the old A and LV leads, and placed in the pocket after irrigation with an antibiotic solution and hemostasis.
The pocket was expanded to accommodate the new generator. After successful DFT testing, the Fidelis lead was cut and capped and tied with 0-silk.
*
DFT testing was performed once, and was appropriately detected and terminated with a single 15J shock.
*
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.
*
*
Measured Data: P wave 2.8, 399 ohms, 0.75 V at 0.4 ms
RV R wave 18 V, 532 ohms, thr 0.5 V at 0.4 ms
LV 608 ohms, thr 0.75 V at 0.4 ms
*
Final Parameters: DDD 50-130; two zone device at 182 BPM and 214 BPM. Rx of 25 j followed by 35 j after ATP.
*
Anesthesia: MAC
*so the physician is saying that we can bill as biv genchange 33264 because the new rv lead is been paid by company so we don't need to bill to patient so hospital but according to description of procedure and cci edits I am thinking it should be 33249?
please help
thanks in advance
Biventricular Icd Gen Change w/ new rv lead
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)]
Cardiomyopathy, dilated, nonischemic [I42.9 (ICD-10-CM)]
Chronic systolic CHF (congestive heart failure), NYHA class 2 [I50.22 (ICD-10-CM)]
Left bundle branch block [I44.7 (ICD-10-CM)]
Ventricular tachycardia [I47.2 (ICD-10-CM)]
Presence of manufacturer-recalled ICD lead, initial encounter [T82.198A (ICD-10-CM)]
Conclusion
Cardiac BiV ICD Pulse Generator Replacement and new RV Lead Operative R
*
Procedure(s): BiV ICD Pulse Generator Replacement
New RV ICD lead
Intra-operative ICD and DFT testing once successfully at 15 j
*
Indications:
ICD ERI
VT
LBBB
Chronic systolic chf FC II
Nonischemic dilated cardiomomyopathy
SSS
Fidelis RV Lead on Recall
*
Hardware Implanted: ## NOT MRI COMPATIBLE DUE TO ABANDONED LEAD ##
Medtronic CLARIA MRI MN DTMA1D4, SN RPC200983H
Medtronic RV ICD lead MN 6935M-62, SN TDL264579V
*
Hardware Explanted:
Medtronic BiV ICD MN D314TRG, SN PRS220191H
*
Hardware Abandoned, cut and capped:
Fidelis Medtronic RV ICD lead MN 6949-65, SN LFJ043962V
*
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 device pocket where the pocket was incised, device delivered, and the leads tested. A single left axillary vein puncture placed a guidewire into the superior vena cava. A tear-away sheath introduced the lead into the superior vena cava where fluoroscopic guidance assisted placement of the active fixation right ventricular lead into the RV apex and then lifted into the distal RV septum where the lead was actively fixated. The lead was anchored to the pectoralis fascial using 0 Ethibond. Pacing and sensing thresholds were obtained. The new RV lead was secured to the device along with the old A and LV leads, and placed in the pocket after irrigation with an antibiotic solution and hemostasis.
The pocket was expanded to accommodate the new generator. After successful DFT testing, the Fidelis lead was cut and capped and tied with 0-silk.
*
DFT testing was performed once, and was appropriately detected and terminated with a single 15J shock.
*
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.
*
*
Measured Data: P wave 2.8, 399 ohms, 0.75 V at 0.4 ms
RV R wave 18 V, 532 ohms, thr 0.5 V at 0.4 ms
LV 608 ohms, thr 0.75 V at 0.4 ms
*
Final Parameters: DDD 50-130; two zone device at 182 BPM and 214 BPM. Rx of 25 j followed by 35 j after ATP.
*
Anesthesia: MAC
*so the physician is saying that we can bill as biv genchange 33264 because the new rv lead is been paid by company so we don't need to bill to patient so hospital but according to description of procedure and cci edits I am thinking it should be 33249?
please help
thanks in advance