JessicaSlone
New
I struggle with these. This was a replacement of a ICD. Based off the procedure information below, is there enough to charge a 93640. I'm not seeing any findings for the device itself so I don't think we can do the 93641 but I could be mistaken.
PROCEDURE AND FINDINGS: The patient was brought to the electrophysiology laboratory in a fasting state. Risks/Benefits/Alternatives had been discussed in detail with the patient in the holding area by myself and the patient expressed their understanding and desire to proceed with the planned procedure. Written documentation of Informed consent was confirmed prior to starting the procedure. Intravenous prophylactic antibiotics were administered prior to the procedure. After the site of implantation was prepped and drapped in the usual sterile fashion and after adequate anesthesia was given, the skin was infiltrated with 1% lidocaine. The skin was incised with a #15 scalpel. Blunt and electrosurgical dissection was carried out to the pulse generator pocket using a Photon Blade. The leads were carefully isolated with blunt and electrosurgical dissection. Careful attention was paid not to damage the leads. The pulse generator was explanted. After removing the pulse generator, a pocket revision was performed with removal of the fibrous capsule. The pocket was then copiously irrigated with antibiotic containing normal saline and subsequently observed. Once adequate hemostasis was confirmed within the pocket, the leads were detached from the pulse generator. The leads were tested for adequate sensing, impedances and pacing thresholds. The lead tips for all leads were cleaned and dried thoroughly. The leads were attached to the appropriate ports on the new pulse generator. Tug testing was performed on all connections. The device and leads were placed within the pocket such that the coiled redundant leads were posterior to the pulse generator. Once again, the device was tested for adequate sensing, impedances and pacing thresholds.
The pulse generator was then sutured to the fascia in a medial location within the pocket using 0-0 silk suture. The pocket was closed with a layer of interrupted 2-0 Vicryl followed by a continuous layer of 4-0 Vicryl. DermaBond was applied to the wound followed by a pressure dressing.
MEASURED DEVICE DATA:
RA lead
sensing: 3.3 mV
impedance: 475 Ohms
Threshold: 0.75 Volts at []0.40 ms
RV lead
sensing: 20 mV
impedance: [532] Ohms HV 58/74
Threshold: [0.75] Volts at [0.4] ms
LV lead
impedance: [1444] Ohms
Threshold: [2.50] Volts at [1.00] ms
PROCEDURE AND FINDINGS: The patient was brought to the electrophysiology laboratory in a fasting state. Risks/Benefits/Alternatives had been discussed in detail with the patient in the holding area by myself and the patient expressed their understanding and desire to proceed with the planned procedure. Written documentation of Informed consent was confirmed prior to starting the procedure. Intravenous prophylactic antibiotics were administered prior to the procedure. After the site of implantation was prepped and drapped in the usual sterile fashion and after adequate anesthesia was given, the skin was infiltrated with 1% lidocaine. The skin was incised with a #15 scalpel. Blunt and electrosurgical dissection was carried out to the pulse generator pocket using a Photon Blade. The leads were carefully isolated with blunt and electrosurgical dissection. Careful attention was paid not to damage the leads. The pulse generator was explanted. After removing the pulse generator, a pocket revision was performed with removal of the fibrous capsule. The pocket was then copiously irrigated with antibiotic containing normal saline and subsequently observed. Once adequate hemostasis was confirmed within the pocket, the leads were detached from the pulse generator. The leads were tested for adequate sensing, impedances and pacing thresholds. The lead tips for all leads were cleaned and dried thoroughly. The leads were attached to the appropriate ports on the new pulse generator. Tug testing was performed on all connections. The device and leads were placed within the pocket such that the coiled redundant leads were posterior to the pulse generator. Once again, the device was tested for adequate sensing, impedances and pacing thresholds.
The pulse generator was then sutured to the fascia in a medial location within the pocket using 0-0 silk suture. The pocket was closed with a layer of interrupted 2-0 Vicryl followed by a continuous layer of 4-0 Vicryl. DermaBond was applied to the wound followed by a pressure dressing.
MEASURED DEVICE DATA:
RA lead
sensing: 3.3 mV
impedance: 475 Ohms
Threshold: 0.75 Volts at []0.40 ms
RV lead
sensing: 20 mV
impedance: [532] Ohms HV 58/74
Threshold: [0.75] Volts at [0.4] ms
LV lead
impedance: [1444] Ohms
Threshold: [2.50] Volts at [1.00] ms