KimberlyAFloyd
Guest
I am struggling with this procedure. It was a failed procedure but modifier 53 and 52 are not allowed to be billed with the 33224. I have copied the procedure note below...any advice would be appreciatated.
Thank you
Kim Floyd, CPC
The patient has congestive heart failure, class III with
dilated cardiomyopathy of less than 25% with QRS above 130. Risks,
benefits, alternatives, gross possible complications, need for team
approach were discussed with the patient and her daughters, and
informed consent was obtained.
A 6-cm incision was made into the left pectoral area with blunt and
sharp dissection. I freed the AICD leads as well as the
defibrillator. I accessed the left axillary vein and advanced
initially a CPS 35 cm then used a CPS wide, then CPS straight through
the procedure, and we tried to advance a QuickFlex 1258T/86 cm micro
into the coronary sinus. the angiography of the coronary sinus in
multiple views showed only 1 very large suitable lateral vein that
was very tortuous. I was not able to stabilize the lead in a
suitable location. After more than 60 minutes of fluoro time, I
decided to stop. The defibrillator was placed back into the pocket,
and the incision closed with 2-0 Vicryl x3 layers and skin staples.
PLAN We will consult CT surgery for possible epicardial lead and
upgrade to Bi-V.
Thank you
Kim Floyd, CPC
The patient has congestive heart failure, class III with
dilated cardiomyopathy of less than 25% with QRS above 130. Risks,
benefits, alternatives, gross possible complications, need for team
approach were discussed with the patient and her daughters, and
informed consent was obtained.
A 6-cm incision was made into the left pectoral area with blunt and
sharp dissection. I freed the AICD leads as well as the
defibrillator. I accessed the left axillary vein and advanced
initially a CPS 35 cm then used a CPS wide, then CPS straight through
the procedure, and we tried to advance a QuickFlex 1258T/86 cm micro
into the coronary sinus. the angiography of the coronary sinus in
multiple views showed only 1 very large suitable lateral vein that
was very tortuous. I was not able to stabilize the lead in a
suitable location. After more than 60 minutes of fluoro time, I
decided to stop. The defibrillator was placed back into the pocket,
and the incision closed with 2-0 Vicryl x3 layers and skin staples.
PLAN We will consult CT surgery for possible epicardial lead and
upgrade to Bi-V.