perkins05
Expert
PREOPERATIVE DIAGNOSIS:
Cardiomyopathy.
POSTOPERATIVE DIAGNOSIS:
Cardiomyopathy.
OPERATIVE PROCEDURE:
Implantation of dual chamber automatic implantable cardiac
defibrillator.
DESCRIPTION OF PROCEDURE:
After placement of adequate intravenous access and arterial line,
general anesthesia was induced. A routine sterile prep and drape
was conducted on the left shoulder and upper chest. A small
incision was made parallel to the clavicle through which subclavian
venous puncture was performed without difficulty x2 and guide wires
passed under fluoroscopic control. The incision was then extended
medially and carried down through soft tissue. Hemostasis was
obtained with the use of the electrocautery. The pectoralis major
muscles were divided in the anatomic direction of its fibers and a
submuscular pocket created. Care was taken to obtain meticulous
hemostasis. Under fluoroscopic control a tearaway sheath was placed
over one of the guide wires through which the right ventricular lead
was advanced and positioned. Electrical testings were performed.
The sheath was removed. The lead was secured at the level of the
incision with sutures around its sewing ring. Over the second
guidewire under fluoroscopic control a separate sheath was
introduced and an atrial lead was advanced, positioned, secured.
Electrical testing was performed. The sheath was subsequently
removed and the device fixed at the level of the incision. The
generator which was a Medtronic D314DRM Protecta XT-DR-UR-MR-DF4 was
brought to the field. Appropriate electrical connections were made
and the device was placed in the previously created submuscular
pocket. The device was programmed and activated. Defibrillation
threshold testing was performed with the device appropriately
identifying and terminating induced ventricular fibrillation with a
shock of 25 watt seconds. The device was not temporarily
deactivated as the wound was closed in layers using absorbable
sutures. Final skin closure was with placement of surgical staples.
At the end of the procedure an appropriate dressing was placed. The
patient was awakened, extubated. The device was programmed,
activated and the patient was transported to the recovery room in
stable condition.
Codes wanting to bill
33249
93641
Any help will be greatly appreciated!
Thanks
Cardiomyopathy.
POSTOPERATIVE DIAGNOSIS:
Cardiomyopathy.
OPERATIVE PROCEDURE:
Implantation of dual chamber automatic implantable cardiac
defibrillator.
DESCRIPTION OF PROCEDURE:
After placement of adequate intravenous access and arterial line,
general anesthesia was induced. A routine sterile prep and drape
was conducted on the left shoulder and upper chest. A small
incision was made parallel to the clavicle through which subclavian
venous puncture was performed without difficulty x2 and guide wires
passed under fluoroscopic control. The incision was then extended
medially and carried down through soft tissue. Hemostasis was
obtained with the use of the electrocautery. The pectoralis major
muscles were divided in the anatomic direction of its fibers and a
submuscular pocket created. Care was taken to obtain meticulous
hemostasis. Under fluoroscopic control a tearaway sheath was placed
over one of the guide wires through which the right ventricular lead
was advanced and positioned. Electrical testings were performed.
The sheath was removed. The lead was secured at the level of the
incision with sutures around its sewing ring. Over the second
guidewire under fluoroscopic control a separate sheath was
introduced and an atrial lead was advanced, positioned, secured.
Electrical testing was performed. The sheath was subsequently
removed and the device fixed at the level of the incision. The
generator which was a Medtronic D314DRM Protecta XT-DR-UR-MR-DF4 was
brought to the field. Appropriate electrical connections were made
and the device was placed in the previously created submuscular
pocket. The device was programmed and activated. Defibrillation
threshold testing was performed with the device appropriately
identifying and terminating induced ventricular fibrillation with a
shock of 25 watt seconds. The device was not temporarily
deactivated as the wound was closed in layers using absorbable
sutures. Final skin closure was with placement of surgical staples.
At the end of the procedure an appropriate dressing was placed. The
patient was awakened, extubated. The device was programmed,
activated and the patient was transported to the recovery room in
stable condition.
Codes wanting to bill
33249
93641
Any help will be greatly appreciated!
Thanks