jlb102780
Guru
Hi Everyone,
Needing some other brains to look at this case below. It looks like the device was placed back in the same pocket. Any thoughts on a CPT code or if this is even billable??
PROCEDURE
ICD pocket revision.
INDICATION FOR STUDY
Briefly, this is a 64-year-old male who had an ICD placed earlier this summer
for ventricular tachycardia and cardiomyopathy. He finds the device
uncomfortable given that it is interacting with his shoulder when he moves
his shoulder. He is, therefore, referred for pocket revision.
PROCEDURE REPORT
The procedure was performed under conscious sedation after he signed informed consent. He was premedicated with IV vancomycin. The patient was prepped and draped in the usual sterile fashion.
We began the procedure by anesthetizing the skin over the previously placed
ICD incision with 1% lidocaine/Xylocaine. We then made an incision over this
incision. We then removed the device from the pocket an placed antibiotics
sponge. We then used electrocautery to extend the pocket medially
inferiorly. Unfortuneately, there was some oozing at the area of the pocket.
This required extensive electrocautery. We then placed the device back into
the pocket and placed the Tyrx antibiotic envelope around this device. At
this point, we then took interrupted 2-0 Vicryl to close off this new pocket
to keep it more medial. We then closed the incision in 5 layers using 1
layer of interrupted 2-0 Vicryl, 2 layers of uninterrupted Vicryl, a layer of
3-0 Vicryl, a layer of 4-0 Vicryl.
Final parameters on the leads are an impedance of 528 ohms and P-wave of 2.2 mV on the atrial lead and a threshold of 0.5 V. On the RV lead, we had an impedance of 459 ohms, an R-wave of 10.7 mV and a threshold of 0.8 V.
Thanks,
Needing some other brains to look at this case below. It looks like the device was placed back in the same pocket. Any thoughts on a CPT code or if this is even billable??
PROCEDURE
ICD pocket revision.
INDICATION FOR STUDY
Briefly, this is a 64-year-old male who had an ICD placed earlier this summer
for ventricular tachycardia and cardiomyopathy. He finds the device
uncomfortable given that it is interacting with his shoulder when he moves
his shoulder. He is, therefore, referred for pocket revision.
PROCEDURE REPORT
The procedure was performed under conscious sedation after he signed informed consent. He was premedicated with IV vancomycin. The patient was prepped and draped in the usual sterile fashion.
We began the procedure by anesthetizing the skin over the previously placed
ICD incision with 1% lidocaine/Xylocaine. We then made an incision over this
incision. We then removed the device from the pocket an placed antibiotics
sponge. We then used electrocautery to extend the pocket medially
inferiorly. Unfortuneately, there was some oozing at the area of the pocket.
This required extensive electrocautery. We then placed the device back into
the pocket and placed the Tyrx antibiotic envelope around this device. At
this point, we then took interrupted 2-0 Vicryl to close off this new pocket
to keep it more medial. We then closed the incision in 5 layers using 1
layer of interrupted 2-0 Vicryl, 2 layers of uninterrupted Vicryl, a layer of
3-0 Vicryl, a layer of 4-0 Vicryl.
Final parameters on the leads are an impedance of 528 ohms and P-wave of 2.2 mV on the atrial lead and a threshold of 0.5 V. On the RV lead, we had an impedance of 459 ohms, an R-wave of 10.7 mV and a threshold of 0.8 V.
Thanks,