lcouto
Networker
I have never billed this before and I am not sure of what codes to bill... Can anyone help please?
Pre-procedure Diagnoses
1. AICD (automatic implantable cardioverter defibrillator) at end of life, initial encounter
Post-procedure Diagnoses
1. AICD (automatic implantable cardioverter defibrillator) at end of life, initial encounter
Procedures
1. PACEMAKER SC GEN CHANGE
BRIEF OPERATIVE NOTE
Pre-operative Diagnosis:
AICD (automatic implantable cardioverter defibrillator) at end of life, initial encounter
Procedure Performed :
Implantation of Permanent Pacemaker
Implants and Procedure Description:
After informed consent was obtained, the patient was transported in a nonsedated condition to the cardiac catheterization suite. The patient was given moderate conscious sedation. The patient was prepped and draped in a sterile fashion and a "timeout" was taken.
Lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the left pectoralis muscle. Sharp incision was made in the skin. Utilizing a combination of sharp and blunt dissection, the old ICD pulse generator was dissected from its pocket in the prepectoral fascia. Defibrillation leads where capped and secured to the pectoralis fascia with 0 silk.
The generator was removed and the leads were tested. The right ventricular lead was a Medtronic 6949 It was tested and found to have R waves of 7.5 mV, impedance 531 ohms, threshold was 0.6 volts, current 1.2 milliamps. The left ventricular lead was a Medtronic 4194 . It was tested and found to have R waves of--- mV, impedance 686 ohms, threshold was 1.0 volts, current 1.6 milliamps.The atrial lead was an active fixation lead, Medtronic 5076 . It was tested and found to have F waves of 3.0 mV, impedance 459 ohms, threshold was AF volts, current AF milliamps. I then attached the new pulse generator, a Medtronic C4TR01 . The leads and pulse generator were incorporated in the pocket. The pocket was copiously irrigated. The subcutaneous fascia was closed with interrupted Vicryl suture. The skin layer was closed with Surgiseal. Final fluoroscopy demonstrated adequate slack in the leads. The wound was dressed in a sterile fashion.
Pre-procedure Diagnoses
1. AICD (automatic implantable cardioverter defibrillator) at end of life, initial encounter
Post-procedure Diagnoses
1. AICD (automatic implantable cardioverter defibrillator) at end of life, initial encounter
Procedures
1. PACEMAKER SC GEN CHANGE
BRIEF OPERATIVE NOTE
Pre-operative Diagnosis:
AICD (automatic implantable cardioverter defibrillator) at end of life, initial encounter
Procedure Performed :
Implantation of Permanent Pacemaker
Implants and Procedure Description:
After informed consent was obtained, the patient was transported in a nonsedated condition to the cardiac catheterization suite. The patient was given moderate conscious sedation. The patient was prepped and draped in a sterile fashion and a "timeout" was taken.
Lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the left pectoralis muscle. Sharp incision was made in the skin. Utilizing a combination of sharp and blunt dissection, the old ICD pulse generator was dissected from its pocket in the prepectoral fascia. Defibrillation leads where capped and secured to the pectoralis fascia with 0 silk.
The generator was removed and the leads were tested. The right ventricular lead was a Medtronic 6949 It was tested and found to have R waves of 7.5 mV, impedance 531 ohms, threshold was 0.6 volts, current 1.2 milliamps. The left ventricular lead was a Medtronic 4194 . It was tested and found to have R waves of--- mV, impedance 686 ohms, threshold was 1.0 volts, current 1.6 milliamps.The atrial lead was an active fixation lead, Medtronic 5076 . It was tested and found to have F waves of 3.0 mV, impedance 459 ohms, threshold was AF volts, current AF milliamps. I then attached the new pulse generator, a Medtronic C4TR01 . The leads and pulse generator were incorporated in the pocket. The pocket was copiously irrigated. The subcutaneous fascia was closed with interrupted Vicryl suture. The skin layer was closed with Surgiseal. Final fluoroscopy demonstrated adequate slack in the leads. The wound was dressed in a sterile fashion.