allowry5
Contributor
Please provide coding guidance. I have had several different coding responses on how to code these. I believe these should be code set 33262-33264 but not everyone agrees. Thank you for any input
PROCEDURE PERFORMED:
1. Venogram
2. New LV lead implant
3. Upgrade from dual chamber ICD to Biventricular Defibrillator .
COMPLICATIONS:
No acute complications.
ESTIMATED BLOOD LOSS:
20 cc
PROCEDURE DESCRIPTION:
Before we then prepped the patient, I performed a venogram. The left subclavian vein was patent.
The left deltopectoral area was prepped and draped in the usual fashion. Lidocaine 1% was used for local analgesia. A 4 cm incision was made. Electrocautery was used to dissect down to the deltopectoral fascia just superior to the existing leads. There was good hemostasis. . An introducer needle was placed in the axillary vein and a guide wire passed through it.
A CS guide sheath was inserted over the next guidewire. Using an AL1 catheter and glidewire I was able to cannulate the coronary sinus fairly easily. Contrast was injected in the CS to visualize the branches. The posterolateral branch was picked as a target. Using a whisper wire I was able to advance a Boston Scientific quadripolar lead into position. We had satisfactory pacing, sensing, and impedance parameters. The CS sheath was then removed without any movement of the LV lead tip. This lead was sewn into place with 0 Ethibond suture.
Electrocautery was then used to dissect down to the existing defibrillator pocket. The defibrillator was removed from the pocket. The pocket was expanded.The pocket was then copiously irrigated with antibiotic solution. The leads were securely connected to the header of the generator. The leads were carefully wrapped around the generator, and the generator was placed in the pocket.
The pocket was then closed with 2-0 and 3-0 Vicryl in a running stitch. Dermabond was placed over the incision. Sponge and needle counts were correct at the end of the procedure.
For device information and analyzer information, see below.
IMPRESSION:
1. SUCCESSFUL NEW LEFT VENTRICULAR LEAD IMPLANT
2. SUCCESSFUL UPGRADE OF DUAL-CHAMBER DEFIBRILLATOR TO BIVENTRICULAR DEFIBRILLATOR
PROCEDURE PERFORMED:
1. Venogram
2. New LV lead implant
3. Upgrade from dual chamber ICD to Biventricular Defibrillator .
COMPLICATIONS:
No acute complications.
ESTIMATED BLOOD LOSS:
20 cc
PROCEDURE DESCRIPTION:
Before we then prepped the patient, I performed a venogram. The left subclavian vein was patent.
The left deltopectoral area was prepped and draped in the usual fashion. Lidocaine 1% was used for local analgesia. A 4 cm incision was made. Electrocautery was used to dissect down to the deltopectoral fascia just superior to the existing leads. There was good hemostasis. . An introducer needle was placed in the axillary vein and a guide wire passed through it.
A CS guide sheath was inserted over the next guidewire. Using an AL1 catheter and glidewire I was able to cannulate the coronary sinus fairly easily. Contrast was injected in the CS to visualize the branches. The posterolateral branch was picked as a target. Using a whisper wire I was able to advance a Boston Scientific quadripolar lead into position. We had satisfactory pacing, sensing, and impedance parameters. The CS sheath was then removed without any movement of the LV lead tip. This lead was sewn into place with 0 Ethibond suture.
Electrocautery was then used to dissect down to the existing defibrillator pocket. The defibrillator was removed from the pocket. The pocket was expanded.The pocket was then copiously irrigated with antibiotic solution. The leads were securely connected to the header of the generator. The leads were carefully wrapped around the generator, and the generator was placed in the pocket.
The pocket was then closed with 2-0 and 3-0 Vicryl in a running stitch. Dermabond was placed over the incision. Sponge and needle counts were correct at the end of the procedure.
For device information and analyzer information, see below.
IMPRESSION:
1. SUCCESSFUL NEW LEFT VENTRICULAR LEAD IMPLANT
2. SUCCESSFUL UPGRADE OF DUAL-CHAMBER DEFIBRILLATOR TO BIVENTRICULAR DEFIBRILLATOR