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My provider coded the report below as: 33225, 75820,26, 99152.........
33225 is an add-on code. As per the report below, I think we should bill a 33263,52, 75820,26, 99152...... Am I correct?
Procedures performed Left upper extremity venography. Permanent pacemaker implantation.
Indications: History 77 y/o M with PMHx of HTN, DM-II, HLD, ESRD (R chest perm cath MWF), HFrEF 30%, CAD s/p multiple stents (most recent stent in 2018), Second degree AV block s/p dual chamber Boston Scientific PPM (7/2019), underwent for cath which showed MVD and per heart team discussion is for medical therpay, pacemaker interrogation showed 99 % RV pacing, patient referred to EPS for BIV ICD upgrade.
Baseline ECG: Atrial sensed ventricular paced rhythm.
Procedure narrative The risks, benefits, and alternatives to the procedure and sedation were explained to the patient and informed consent was obtained. The patient has a previously implanted device, a dual-chamber permanent pacemaker ( Boston Scientific) in the left infraclavicular position, with RA appendage and RV mid septum leads. The device was interrogated and the parameters recorded. The patient was in the fasting state. A baseline ECG was recorded. A grounding pad was placed on the right thigh. Self-adhesive anterior-apical defibrillation pads were applied. A Physio Control (model LIFEPAK 12) defibrillator was used. The defibrillator waveform was set to biphasic and energy was dialed to 200 Joules. The patient was set up for monitoring of surface ECG, telemetered electrograms, pulse oximetry, and end-tidal CO2. Blood pressure was monitored with automatic cuff measurements. The procedure was performed under IV conscious sedation. The left infraclavicular region and groins were clipped, prepped with chlorhexidine, and draped in the usual sterile fashion. Local anesthesia: Lidocaine 1 % ( 10 ml) to the left infraclavicular region. Bupivacaine 1.3 % ( 10 ml) to the left infraclavicular region.
1. Left upper extremity venography was performed. The procedure was performed before starting the case. Contrast (Omnipaque, 20 ml) was injected through a 20 gauge angiocath into a left peripheral vein. Images were obtained. Central veins in the upper extremity were visualized and severe stenosis of the left innominate vein with the SVC.
2. A subcutaneous left infraclavicular pocket was opened with an incision over the previous one. The appearance was normal.
3. Left axillary vein access was obtained. The vessel was accessed using the modified Seldinger technique during radiocontrast dye infusion.
4. A permanent pacemaker ( Boston Scientific, Accolade, L311, SN 424276) was attached to the lead(s), encased in a Tyrx pouch and implanted (Medtronic, Ref CMRM6133, Lot R198380). It was anchored to the underlying fascia with nonabsorbable sutures.
5. Hemostasis was obtained with electrocautery. Pocket closure was obtained. The pocket was flushed with saline and vancomycin. The wound was closed in two layers. The skin was approximated with Clozex. A pressure dressing was applied.
SUMMARY: unSuccessful attempt for BIV ICD upgrade from dual permanent pacemaker due to sever stenosis of the left innominate vein at the junction of the SVC despite multiple attempt with deferent wire. ·
33225 is an add-on code. As per the report below, I think we should bill a 33263,52, 75820,26, 99152...... Am I correct?
Procedures performed Left upper extremity venography. Permanent pacemaker implantation.
Indications: History 77 y/o M with PMHx of HTN, DM-II, HLD, ESRD (R chest perm cath MWF), HFrEF 30%, CAD s/p multiple stents (most recent stent in 2018), Second degree AV block s/p dual chamber Boston Scientific PPM (7/2019), underwent for cath which showed MVD and per heart team discussion is for medical therpay, pacemaker interrogation showed 99 % RV pacing, patient referred to EPS for BIV ICD upgrade.
Baseline ECG: Atrial sensed ventricular paced rhythm.
Procedure narrative The risks, benefits, and alternatives to the procedure and sedation were explained to the patient and informed consent was obtained. The patient has a previously implanted device, a dual-chamber permanent pacemaker ( Boston Scientific) in the left infraclavicular position, with RA appendage and RV mid septum leads. The device was interrogated and the parameters recorded. The patient was in the fasting state. A baseline ECG was recorded. A grounding pad was placed on the right thigh. Self-adhesive anterior-apical defibrillation pads were applied. A Physio Control (model LIFEPAK 12) defibrillator was used. The defibrillator waveform was set to biphasic and energy was dialed to 200 Joules. The patient was set up for monitoring of surface ECG, telemetered electrograms, pulse oximetry, and end-tidal CO2. Blood pressure was monitored with automatic cuff measurements. The procedure was performed under IV conscious sedation. The left infraclavicular region and groins were clipped, prepped with chlorhexidine, and draped in the usual sterile fashion. Local anesthesia: Lidocaine 1 % ( 10 ml) to the left infraclavicular region. Bupivacaine 1.3 % ( 10 ml) to the left infraclavicular region.
1. Left upper extremity venography was performed. The procedure was performed before starting the case. Contrast (Omnipaque, 20 ml) was injected through a 20 gauge angiocath into a left peripheral vein. Images were obtained. Central veins in the upper extremity were visualized and severe stenosis of the left innominate vein with the SVC.
2. A subcutaneous left infraclavicular pocket was opened with an incision over the previous one. The appearance was normal.
3. Left axillary vein access was obtained. The vessel was accessed using the modified Seldinger technique during radiocontrast dye infusion.
4. A permanent pacemaker ( Boston Scientific, Accolade, L311, SN 424276) was attached to the lead(s), encased in a Tyrx pouch and implanted (Medtronic, Ref CMRM6133, Lot R198380). It was anchored to the underlying fascia with nonabsorbable sutures.
5. Hemostasis was obtained with electrocautery. Pocket closure was obtained. The pocket was flushed with saline and vancomycin. The wound was closed in two layers. The skin was approximated with Clozex. A pressure dressing was applied.
SUMMARY: unSuccessful attempt for BIV ICD upgrade from dual permanent pacemaker due to sever stenosis of the left innominate vein at the junction of the SVC despite multiple attempt with deferent wire. ·