kokomax
Contributor
Hello! I am needing some help with coding this procedure...I believe it is 33228 and 33215...any help would be greatly appreciated!!
After positioning the patient and prepping and draping a sterile field, the region of the existing device left deltopectoral groove was liberally infiltrated with a local anesthetic agent. Radiocontrast dye was injected into a peripheral vein in order to determine the location and patentcy of the axillary/subclavian vein. Following this, a 5 cm long transverse incision was made through the skin and subcutaneous tissue, opening the pocket and exposing the device. The pulse generator was then freed from the surrounding tissue and removed from the pocket. Hemostasis was readily achieved with electrocautery. The axillary vein was punctured and cannulated using the modified Seldinger technique, leaving a guidewire in place. A peel-away sheath was inserted over one guidewire and the ventricular lead was positioned in the RV apical septum using fluoroscopic guidance; satisfactory pacing thresholds and R waves were obtained as detailed below. The lead was secured in place at its entry to the vein. High-volt pacing was used temporarily and assessment made for diaphragmatic stimulation; there was none. The previously-formed pocket was irrigated with antibiotic solution as was the rest of the incision. After this, the existing leads were disconnected from the old pulse generator. The old right ventricular lead was capped. The existing right atrial lead and the newly implanted right ventricular lead were connected securely to the new pulse generator. The leads were wrapped carefully behind the generator, placed in a TYRX pouch to reduce the risk of infection, and placed in the pocket. Wireless interrogation was carried out, ensuring normal sensing and pacing function of the entire system. Hemostasis was assured one last time and the pocket closed. The pectoral fascia was closed with 2-0 Vicryl using interrupted sutures. The subcutaneous layer was closed with 3-0 Vicryl using running stitches. Steri-Strips were used for skin closure. A sterile dressing was then applied. Sponge and needle counts were correct at the end.
Thank you!!
After positioning the patient and prepping and draping a sterile field, the region of the existing device left deltopectoral groove was liberally infiltrated with a local anesthetic agent. Radiocontrast dye was injected into a peripheral vein in order to determine the location and patentcy of the axillary/subclavian vein. Following this, a 5 cm long transverse incision was made through the skin and subcutaneous tissue, opening the pocket and exposing the device. The pulse generator was then freed from the surrounding tissue and removed from the pocket. Hemostasis was readily achieved with electrocautery. The axillary vein was punctured and cannulated using the modified Seldinger technique, leaving a guidewire in place. A peel-away sheath was inserted over one guidewire and the ventricular lead was positioned in the RV apical septum using fluoroscopic guidance; satisfactory pacing thresholds and R waves were obtained as detailed below. The lead was secured in place at its entry to the vein. High-volt pacing was used temporarily and assessment made for diaphragmatic stimulation; there was none. The previously-formed pocket was irrigated with antibiotic solution as was the rest of the incision. After this, the existing leads were disconnected from the old pulse generator. The old right ventricular lead was capped. The existing right atrial lead and the newly implanted right ventricular lead were connected securely to the new pulse generator. The leads were wrapped carefully behind the generator, placed in a TYRX pouch to reduce the risk of infection, and placed in the pocket. Wireless interrogation was carried out, ensuring normal sensing and pacing function of the entire system. Hemostasis was assured one last time and the pocket closed. The pectoral fascia was closed with 2-0 Vicryl using interrupted sutures. The subcutaneous layer was closed with 3-0 Vicryl using running stitches. Steri-Strips were used for skin closure. A sterile dressing was then applied. Sponge and needle counts were correct at the end.
Thank you!!