Recently a physician removed a Dual ICD and both Leads via Laser extraction due to a pocket infection. After the removal of the equipment the pocket was clean out and a drain inserted and sutured into pocket. I am curious if CPT code 10180 I&D for infection should be added to the Codes 33241(ICD removal) and 33244(ICD lead removal) or is every thing covered on CPT 33244? I am attached ing op report. I would appreciate your thoughts.
*
TECHNIQUE: *
*
Attention was then turned to the chest wall. An incision was made along
the prior cicatrix line. Even though purulent material was not expressed
prior to draping today, once we incised the incision, a significant
amount of purulent material was present. After removing the hardware, we
also got deeper wound cultures not only of the purulent material but
some of the deeper tissues as well. Those were sent off to microbiology
for analysis as was the hardware.
*
Following this culture, we then irrigated with bacitracin solution with
significant amounts of irrigation to cleanse the pocket prior to
debridement and removal of devitalized tissue. There was no significant
calcification in the chronic pocket. Subcutaneous debridement was
performed and then the lead was prepped. prepped. ...*
At this point, it was clear we had to use the laser sheath. We decided to use the 14-
French Spectranetics laser sheath. It was calibrated; initially starting
at 40 Hz. We did laser under the clavicle, innominate with some lasering
required in the superior vena cava. Surprisingly, this active helix
mechanism on this Fidelis did retract despite nearly 10 years in-vivo.
The lead tip was fully freed as was the RV coil. The lead was then
brought back additionally to around the level of the SVC but would not
come back in the sheath. We tried to remove the entire apparatus
together. There still were some adhesions requiring some additional few
seconds of laser time to free up scar tissue and fibrosis.
*
Ultimately, everything was removed in its entirety and sent off for
analysis. At the conclusion of the case, the pocket was inspected one
last time. Hemostasis was achieved. It was irrigated and then a tunnel
was created using the Metzenbaum scissors and a scalpel at the lateral
inferior margin. A bulb drain was placed on the tip of that and sutured
into place. The drain and the margins were closed with nonabsorbable 0 -
Suture in an interrupted mattress fashion. A light pressure dressing was *
placed on top.
*
TECHNIQUE: *
*
Attention was then turned to the chest wall. An incision was made along
the prior cicatrix line. Even though purulent material was not expressed
prior to draping today, once we incised the incision, a significant
amount of purulent material was present. After removing the hardware, we
also got deeper wound cultures not only of the purulent material but
some of the deeper tissues as well. Those were sent off to microbiology
for analysis as was the hardware.
*
Following this culture, we then irrigated with bacitracin solution with
significant amounts of irrigation to cleanse the pocket prior to
debridement and removal of devitalized tissue. There was no significant
calcification in the chronic pocket. Subcutaneous debridement was
performed and then the lead was prepped. prepped. ...*
At this point, it was clear we had to use the laser sheath. We decided to use the 14-
French Spectranetics laser sheath. It was calibrated; initially starting
at 40 Hz. We did laser under the clavicle, innominate with some lasering
required in the superior vena cava. Surprisingly, this active helix
mechanism on this Fidelis did retract despite nearly 10 years in-vivo.
The lead tip was fully freed as was the RV coil. The lead was then
brought back additionally to around the level of the SVC but would not
come back in the sheath. We tried to remove the entire apparatus
together. There still were some adhesions requiring some additional few
seconds of laser time to free up scar tissue and fibrosis.
*
Ultimately, everything was removed in its entirety and sent off for
analysis. At the conclusion of the case, the pocket was inspected one
last time. Hemostasis was achieved. It was irrigated and then a tunnel
was created using the Metzenbaum scissors and a scalpel at the lateral
inferior margin. A bulb drain was placed on the tip of that and sutured
into place. The drain and the margins were closed with nonabsorbable 0 -
Suture in an interrupted mattress fashion. A light pressure dressing was *
placed on top.