JessicaSlone
New
Hello,
I'm torn between two sets of codes and I'm hoping for some insight.
The 1st set of codes I get are 33225, 33229
the 2nd set of codes are 33235, 33233, 33207,33225
We began with a abbot pulse generator pm3222 and ended with a pm 3562 (Both are biventricular devices)
Below is the procedure note.
The patient was brought to the electrophysiology laboratory in a fasting state. Risks/Benefits/Alternatives had been discussed in detail with the patient in the holding area by myself and the patient expressed their understanding and desire to proceed with the planned procedure. Written documentation of Informed consent was confirmed prior to starting the procedure. Intravenous prophylactic antibiotics were administered prior to the procedure. After the site of implantation was prepped and draped in the usual sterile fashion and after adequate anesthesia was given, the skin was infiltrated with 1% lidocaine.
Initially a LUE venogram was performed revealing patency of the left SV. This was cannulated with a micro puncture kit and a 10F sheath was placed. Through this we delivered the sheath into the CS. The vein that the lv lead was in was the only available target however the lead was very proximally in the vein so we attempted and were able to achieve placement of a new quad lead distally and archived better threshold albeit with some phrenic nerve stim, The sheath was cut away and the lead secured to the muscle with Ethabond sutures.
The skin was incised with a #15 scalpel. Blunt and electrosurgical dissection was carried out to the pulse generator pocket using a Photon Blade. The leads were carefully isolated with blunt and electrosurgical dissection. Careful attention was paid not to damage the leads. The pulse generator was explanted. After removing the pulse generator, a pocket revision was performed with removal of the fibrous capsule. The pocket was then copiously irrigated with antibiotic containing normal saline and subsequently observed. Arista powder was applied in the pocket to assist with hemostasis. Once adequate hemostasis was confirmed within the pocket, the leads were detached from the pulse generator. The leads were tested for adequate sensing, impedances and pacing thresholds. The lead tips for all leads were cleaned and dried thoroughly. The leads were attached to the appropriate ports on the new pulse generator. The device and leads were placed within the pocket such that the coiled redundant leads were posterior to the pulse generator. Once again, the device was tested for adequate sensing, impedances and pacing thresholds.
A antibiotic pouch was placed in the pocket and the old LV bipolar lead was capped and placed posteriorly to the new device.
MEASURED DEVICE DATA:
RA lead
sensing: 1.0 mV
impedance: 390 Ohms
Threshold: 1.0 Volts at 0.5 ms
RV lead
sensing: 7.3 mV
impedance: 450 Ohms
Threshold: 1.25 Volts at 0.5 ms
LV Lead
impedance: 700 Ohms
Threshold: 0.75 Volts at 1.0 ms
CONCLUSION: Successful pacemaker generator change.
I'm torn between two sets of codes and I'm hoping for some insight.
The 1st set of codes I get are 33225, 33229
the 2nd set of codes are 33235, 33233, 33207,33225
We began with a abbot pulse generator pm3222 and ended with a pm 3562 (Both are biventricular devices)
Below is the procedure note.
The patient was brought to the electrophysiology laboratory in a fasting state. Risks/Benefits/Alternatives had been discussed in detail with the patient in the holding area by myself and the patient expressed their understanding and desire to proceed with the planned procedure. Written documentation of Informed consent was confirmed prior to starting the procedure. Intravenous prophylactic antibiotics were administered prior to the procedure. After the site of implantation was prepped and draped in the usual sterile fashion and after adequate anesthesia was given, the skin was infiltrated with 1% lidocaine.
Initially a LUE venogram was performed revealing patency of the left SV. This was cannulated with a micro puncture kit and a 10F sheath was placed. Through this we delivered the sheath into the CS. The vein that the lv lead was in was the only available target however the lead was very proximally in the vein so we attempted and were able to achieve placement of a new quad lead distally and archived better threshold albeit with some phrenic nerve stim, The sheath was cut away and the lead secured to the muscle with Ethabond sutures.
The skin was incised with a #15 scalpel. Blunt and electrosurgical dissection was carried out to the pulse generator pocket using a Photon Blade. The leads were carefully isolated with blunt and electrosurgical dissection. Careful attention was paid not to damage the leads. The pulse generator was explanted. After removing the pulse generator, a pocket revision was performed with removal of the fibrous capsule. The pocket was then copiously irrigated with antibiotic containing normal saline and subsequently observed. Arista powder was applied in the pocket to assist with hemostasis. Once adequate hemostasis was confirmed within the pocket, the leads were detached from the pulse generator. The leads were tested for adequate sensing, impedances and pacing thresholds. The lead tips for all leads were cleaned and dried thoroughly. The leads were attached to the appropriate ports on the new pulse generator. The device and leads were placed within the pocket such that the coiled redundant leads were posterior to the pulse generator. Once again, the device was tested for adequate sensing, impedances and pacing thresholds.
A antibiotic pouch was placed in the pocket and the old LV bipolar lead was capped and placed posteriorly to the new device.
MEASURED DEVICE DATA:
RA lead
sensing: 1.0 mV
impedance: 390 Ohms
Threshold: 1.0 Volts at 0.5 ms
RV lead
sensing: 7.3 mV
impedance: 450 Ohms
Threshold: 1.25 Volts at 0.5 ms
LV Lead
impedance: 700 Ohms
Threshold: 0.75 Volts at 1.0 ms
CONCLUSION: Successful pacemaker generator change.