amym
Guest
Is it appropriate to bill this as 33249-Q0 and 33225?
Permanent transvenous biventricular defibrillator implant for primary prevention:
Procedure: After sterile preparation of the skin surrounding the left deltopectoral area with antiseptic scrub, this area was carefully covered with Steri-Drape
followed by the application of sterile towels and as well as
laparotomy sheet. Local anesthesia with 1% lidocaine was
administered and approximately 2 inch incision across the left
deltopectoral groove was made. Using blunt dissection with careful
hemostasis, the left cephalic vein was isolated and two guidewires
inserted between two silk ties. The left axillary vein was also
accessed and third guidewire was inserted.
The right ventricular lead is a Medtronic cm serial number
TDL was advanced into the right ventricular apex and active
fixation mechanism deployed. This was placed through the left
cephalic vein.
The right atrial lead was advanced, which is a Medtronic CapSureFix,
model number cm, serial number , was advanced to
the left cephalic vein and positioned into the right atrial
appendage and active fixation mechanism deployed.
Through a 9-French sheath in the left axillary vein, a Long MB
coronary sinus sheath was advanced over a glidewire and coronary
sinus cannulated. A selective venogram was performed, which showed
a satisfactory sized lateral branch of the coronary sinus which was
used as targeted branch. The left ventricular lead is Attain
Ability model number cm serial number was
positioned into the lateral branch of the coronary sinus with good
pacing and sensing thresholds. There was no phrenic nerve capture
below five volts.
Sheaths were aspirated and removed and the leads were secured to the
underlying soft tissue with 2-0 Ethibond sutures. The leads were
then carefully aligned into the defibrillator header and tightened
with a wrench. The permanent cardioverter-defibrillator device is a
Medtronic serial number .
Pace sense parameters were measured through the device were as
following:
1. Right ventricular lead R-wave of 6.9 mV with pacing impedance
of 411 ohms and pacing threshold of 0.4 V at 0.5 msec.
2. Right atrial lead P-wave of 2.3 mV pacing impedance of 593
ohms and pacing threshold of 0.8 V at 0.44 msec.
3. Left ventricular lead R-wave of 4.6 mV with pacing impedance
of 696 ohms and pacing threshold of 1 V at 0.4 msec.
The device was secured to the underlying pectoral fascia after
creating subcutaneous pectoral pocket with blunt dissection with
careful hemostasis. The pocket was irrigated with antibiotic
solution. The subcutaneous tissue was closed in layers with
absorbable suture. The skin was closed with continuous absorbable
suture. Sterile occlusive dressing was applied and a pressure pad
was applied on top of that. The patient was transferred to
monitoring area in stable condition.
Complications: None.
Comments: Successful CRT-D implant
Permanent transvenous biventricular defibrillator implant for primary prevention:
Procedure: After sterile preparation of the skin surrounding the left deltopectoral area with antiseptic scrub, this area was carefully covered with Steri-Drape
followed by the application of sterile towels and as well as
laparotomy sheet. Local anesthesia with 1% lidocaine was
administered and approximately 2 inch incision across the left
deltopectoral groove was made. Using blunt dissection with careful
hemostasis, the left cephalic vein was isolated and two guidewires
inserted between two silk ties. The left axillary vein was also
accessed and third guidewire was inserted.
The right ventricular lead is a Medtronic cm serial number
TDL was advanced into the right ventricular apex and active
fixation mechanism deployed. This was placed through the left
cephalic vein.
The right atrial lead was advanced, which is a Medtronic CapSureFix,
model number cm, serial number , was advanced to
the left cephalic vein and positioned into the right atrial
appendage and active fixation mechanism deployed.
Through a 9-French sheath in the left axillary vein, a Long MB
coronary sinus sheath was advanced over a glidewire and coronary
sinus cannulated. A selective venogram was performed, which showed
a satisfactory sized lateral branch of the coronary sinus which was
used as targeted branch. The left ventricular lead is Attain
Ability model number cm serial number was
positioned into the lateral branch of the coronary sinus with good
pacing and sensing thresholds. There was no phrenic nerve capture
below five volts.
Sheaths were aspirated and removed and the leads were secured to the
underlying soft tissue with 2-0 Ethibond sutures. The leads were
then carefully aligned into the defibrillator header and tightened
with a wrench. The permanent cardioverter-defibrillator device is a
Medtronic serial number .
Pace sense parameters were measured through the device were as
following:
1. Right ventricular lead R-wave of 6.9 mV with pacing impedance
of 411 ohms and pacing threshold of 0.4 V at 0.5 msec.
2. Right atrial lead P-wave of 2.3 mV pacing impedance of 593
ohms and pacing threshold of 0.8 V at 0.44 msec.
3. Left ventricular lead R-wave of 4.6 mV with pacing impedance
of 696 ohms and pacing threshold of 1 V at 0.4 msec.
The device was secured to the underlying pectoral fascia after
creating subcutaneous pectoral pocket with blunt dissection with
careful hemostasis. The pocket was irrigated with antibiotic
solution. The subcutaneous tissue was closed in layers with
absorbable suture. The skin was closed with continuous absorbable
suture. Sterile occlusive dressing was applied and a pressure pad
was applied on top of that. The patient was transferred to
monitoring area in stable condition.
Complications: None.
Comments: Successful CRT-D implant
