bcousey26
Networker
Greetings,
Can I request the assistance of a seasoned coder or one who specializes in EP with coding the below report? This report is difficult....I've re-typed the report verbatim from the actual report. The *** are also referred to in the report.
Procedure Performed:
1. Cardiac resynchronization therapy device pulse generator extraction (CRT-D)
2. Right atrial pacemaker Laser Lead extraction x 2.
3. Right ventricular pacemaker Laser Lead extraction.
4. Right ventricular pacemaker lead implanation.
5. Permanent pacemaker implantion.
Indication:
***
Indications:
The patient is a 62-year-old gentleman with ahistory of cardiomyopathy and atrial fibrillation, who was pacemaker dependent, who presented with chronic pocket infection of this CRT-D device. He had E. coli growing from this site, and therefore, he was brough for system extraction.
Description of procedure:
After obtaining informed consent, the patient was brough to the operatinf room. He was prepped and drapped in the usual sterile fashion. Sedarion was administered by the anesthesiologist and an arterial line was place by him as well. The right fermoal area was also prepped. The right CRT-D site was then infiltrated with Marcaine, and using a #10 blade, incision was then ellipsed around the 2 fistulas *** the pocket. Using a combination of blunt dissection and electrocautery, this area was opened up and infected tissue was then removed. The device was ultimately removed and all leads were free up to the suture collar.
Next, right IJ access was obtained and a 7-French sheath was then placed into the right IJ vein. Through this, a Medtronic pacemaker lead, model number 407652, serial number VVL881303V, advanced to the right ventricular apical septum. The innter screw was deployed and the lead was then challenged. The lead was then connected to both cables and threhold was 0.6 V and 0.5 msec, impedance of 785 ohms, R waves of 14mV. *** beats per minute. The CRT-D was then removed aand all leads were attempted to have their innter screws *** locking stylets after the tips were cut off. The *** were also prepped with #2 Ethibond suture. A #16 French *** was then utilized to free up all the leads. Both atrial leads were removed after leasing the proximal portions of these leads. One of them was an old retained lead. One of the leads was a St. Jude Medical, model number 1488 ***. serial number DN15762, *** December 11, 2003. The other lead was an unknown lead, but was also in the right atrium and was ***.
Next, a Boston Scientific Endotak dual coil ICD lead was prepped, which was model number 0144, serial number 304191, placed December 11, 2003. *** straight up to the distal coil and I had difficulty *** remove this, as it was *** right ventricular inferior floor. The left ventricular lead was also prepped and broke midway down from the insulation, but the coil did not. Actually, after unraveling the coil with the laser sheath, the entire lead was removed, which was a Medtronic 4196, serial number PVI662242V and placed December ***. *** was then applied to the Endotak lead, and ultimately, all of it was removed, except for the distal coil which remained in case and attached to the floor of the right ventricle.
The right femoral vein was then prepped and a *** was then advanced into the right femoral vein. Through this, a needle *** was attempted to be used to snate the insulation that was still left from the distal coil. However, this was *** done, and due to tis vigorous adherence to the ventricular wall, this was abandoned.
Attention was then placed back up to the original device site, and 100mL of purelent discharge was removed. Cultures were also sent. All infected ittuse was then removed. A Jackson-Pratt drain was then placed into the pocket and *** closed. The pocket was vigorously irrigated *** normal saline. *** was then closed with interrupted #0 Prolene sutures. Of note, the *** CRT-D devive was a Medtronic, model number D274TRK, serial number ***.
This patient and this case necessitated twice the level of expertise and high level ***. There was also a high level of *** permanent pacemaker placed *** as well as the end of the case. He also had access from the right femoral vein with *** and ***. All leads were removed ***. *** the patient's family.
Thank you for allowing me to participating in the care of this patient.
Any help on coding this report is greatly appreciated.
Thank you in advance.
Can I request the assistance of a seasoned coder or one who specializes in EP with coding the below report? This report is difficult....I've re-typed the report verbatim from the actual report. The *** are also referred to in the report.
Procedure Performed:
1. Cardiac resynchronization therapy device pulse generator extraction (CRT-D)
2. Right atrial pacemaker Laser Lead extraction x 2.
3. Right ventricular pacemaker Laser Lead extraction.
4. Right ventricular pacemaker lead implanation.
5. Permanent pacemaker implantion.
Indication:
***
Indications:
The patient is a 62-year-old gentleman with ahistory of cardiomyopathy and atrial fibrillation, who was pacemaker dependent, who presented with chronic pocket infection of this CRT-D device. He had E. coli growing from this site, and therefore, he was brough for system extraction.
Description of procedure:
After obtaining informed consent, the patient was brough to the operatinf room. He was prepped and drapped in the usual sterile fashion. Sedarion was administered by the anesthesiologist and an arterial line was place by him as well. The right fermoal area was also prepped. The right CRT-D site was then infiltrated with Marcaine, and using a #10 blade, incision was then ellipsed around the 2 fistulas *** the pocket. Using a combination of blunt dissection and electrocautery, this area was opened up and infected tissue was then removed. The device was ultimately removed and all leads were free up to the suture collar.
Next, right IJ access was obtained and a 7-French sheath was then placed into the right IJ vein. Through this, a Medtronic pacemaker lead, model number 407652, serial number VVL881303V, advanced to the right ventricular apical septum. The innter screw was deployed and the lead was then challenged. The lead was then connected to both cables and threhold was 0.6 V and 0.5 msec, impedance of 785 ohms, R waves of 14mV. *** beats per minute. The CRT-D was then removed aand all leads were attempted to have their innter screws *** locking stylets after the tips were cut off. The *** were also prepped with #2 Ethibond suture. A #16 French *** was then utilized to free up all the leads. Both atrial leads were removed after leasing the proximal portions of these leads. One of them was an old retained lead. One of the leads was a St. Jude Medical, model number 1488 ***. serial number DN15762, *** December 11, 2003. The other lead was an unknown lead, but was also in the right atrium and was ***.
Next, a Boston Scientific Endotak dual coil ICD lead was prepped, which was model number 0144, serial number 304191, placed December 11, 2003. *** straight up to the distal coil and I had difficulty *** remove this, as it was *** right ventricular inferior floor. The left ventricular lead was also prepped and broke midway down from the insulation, but the coil did not. Actually, after unraveling the coil with the laser sheath, the entire lead was removed, which was a Medtronic 4196, serial number PVI662242V and placed December ***. *** was then applied to the Endotak lead, and ultimately, all of it was removed, except for the distal coil which remained in case and attached to the floor of the right ventricle.
The right femoral vein was then prepped and a *** was then advanced into the right femoral vein. Through this, a needle *** was attempted to be used to snate the insulation that was still left from the distal coil. However, this was *** done, and due to tis vigorous adherence to the ventricular wall, this was abandoned.
Attention was then placed back up to the original device site, and 100mL of purelent discharge was removed. Cultures were also sent. All infected ittuse was then removed. A Jackson-Pratt drain was then placed into the pocket and *** closed. The pocket was vigorously irrigated *** normal saline. *** was then closed with interrupted #0 Prolene sutures. Of note, the *** CRT-D devive was a Medtronic, model number D274TRK, serial number ***.
This patient and this case necessitated twice the level of expertise and high level ***. There was also a high level of *** permanent pacemaker placed *** as well as the end of the case. He also had access from the right femoral vein with *** and ***. All leads were removed ***. *** the patient's family.
Thank you for allowing me to participating in the care of this patient.
Any help on coding this report is greatly appreciated.
Thank you in advance.