jlb102780
Guru
Hi everyone. Can someone help with coding this report. I don't see these cases too often. Thanks in advanced!! 
Here's how I coded it:
33233 DX:996.01
33213 996.01
71090-26 996.01
33210-59 427.81
71090-26,59 427.81
NAME OF TEST:
1. DDDR permanent pacemaker battery change out.
2. Insertion of a transvenous temporary ventricular pacemaker via the
right femoral vein.
HISTORY
The patient is a very pleasant, 80-year-old male who has a history of sick
sinus syndrome and complete heart block. He had a Medtronic permanent
pacemaker implanted by me back in 2002. He has been followed in our office
regularly. He was seen in the office and noted to be at elective
replacement. He was brought in to have a DDDR permanent pacemaker battery
change out procedure performed. The patient was noted to be pacemaker
dependent in the ventricular chamber. Arrangements were made for the patient
to have a temporary pacemaker placed as well.
PROCEDURE
The patient was brought to the cardiac catheterization laboratory in very
stable condition. Both groins were prepped and draped in the usual sterile
fashion. Both subclavian areas were prepped and draped as well. We first
turned our attention to the right femoral area. Using 1% Xylocaine, the
right femoral area was anesthetized. The patient was given some intravenous
sedation. Please see the accompanying nursing data sheet for full details
regarding his sedation. We then successfully cannulated the right femoral
vein and a 6 French sheath was placed without difficulty. A 5 French
temporary ventricular pacemaker catheter was then placed without difficulty
in the right ventricle. Excellent thresholds were obtained. We then placed
the temporary pacemaker at a backup rate of 50 beats per minute on full
demand pacing.
We then turned our attention to the left subclavian area. I exchanged out
for a new sterile gown and new sterile gloves. Using 1% Xylocaine, we
anesthetized the left subclavian area in the subcutaneous tissue over the old
permanent pacemaker pulse generator. Using a scalpel, a 4 cm horizontal
incision was then made into the subclavian area over the old permanent
pacemaker pulse generator. The pacemaker capsule was then entered.
Utilizing a curved hemostat, I was able to dissect out the old permanent
pacemaker pulse generator from the pacemaker capsule. The old permanent
pacemaker pulse generator was then brought out to the surface of the skin.
We then disconnected both leads from the old permanent pacemaker pulse
generator. We checked thresholds on both leads. From the atrial lead they
were as follows:
1. Voltage 0.4 volts.
2. P wave 4.1 millivolts.
3. Resistance 513 ohms.
These thresholds in the atrial lead were thought to be quite good, especially
for chronic thresholds. I then checked the thresholds on the ventricular
lead. They were as follows:
1. Voltage 0.7 volts.
2. R wave 8.5 millivolts.
3. Resistance 972 ohms.
These thresholds were also thought to be quite good with regards to the
ventricular lead as well. We then irrigated out the pacemaker pocket very
vigorously with antibiotic solution. I took a piece of 4 x 4 gauze and
saturated it with antibiotic solution. I then proceeded to wipe down both
pacemaker leads very carefully as well as then new permanent pacemaker pulse
generator. We connected the new permanent pacemaker pulse generator to both
leads. I documented adequate capture in both leads. We then used the
sterile programming head in order to program the new permanent pacemaker
pulse generator. During this time, the new permanent pacemaker pulse
generator and excess pacemaker leads were placed in the pacemaker pocket.
The subcutaneous tissue was closed in an interrupted layer of 2-0 Vicryl
suture. The skin was then closed with staples. During this time, the
temporary pacemaker leads was removed under fluoroscopy without difficulty.
The explanted pacemaker was a Medtronic, model #KDR901. The new permanent
pacemaker pulse generator is a Medtronic Versa, model #VEDR01, serial
#NWH223704H. The pacemaker is set in the DDD mode at a lower rate of 60 and
upper rate of 120 beats per minute. Both chambers were set at nominal
settings. Both leads were set in a bipolar configuration.
CONCLUSION
1. Successful DDDR permanent pacemaker battery change out.
2. Successful insertion of a transvenous temporary ventricular pacemaker
via the right femoral vein.
Here's how I coded it:
33233 DX:996.01
33213 996.01
71090-26 996.01
33210-59 427.81
71090-26,59 427.81
NAME OF TEST:
1. DDDR permanent pacemaker battery change out.
2. Insertion of a transvenous temporary ventricular pacemaker via the
right femoral vein.
HISTORY
The patient is a very pleasant, 80-year-old male who has a history of sick
sinus syndrome and complete heart block. He had a Medtronic permanent
pacemaker implanted by me back in 2002. He has been followed in our office
regularly. He was seen in the office and noted to be at elective
replacement. He was brought in to have a DDDR permanent pacemaker battery
change out procedure performed. The patient was noted to be pacemaker
dependent in the ventricular chamber. Arrangements were made for the patient
to have a temporary pacemaker placed as well.
PROCEDURE
The patient was brought to the cardiac catheterization laboratory in very
stable condition. Both groins were prepped and draped in the usual sterile
fashion. Both subclavian areas were prepped and draped as well. We first
turned our attention to the right femoral area. Using 1% Xylocaine, the
right femoral area was anesthetized. The patient was given some intravenous
sedation. Please see the accompanying nursing data sheet for full details
regarding his sedation. We then successfully cannulated the right femoral
vein and a 6 French sheath was placed without difficulty. A 5 French
temporary ventricular pacemaker catheter was then placed without difficulty
in the right ventricle. Excellent thresholds were obtained. We then placed
the temporary pacemaker at a backup rate of 50 beats per minute on full
demand pacing.
We then turned our attention to the left subclavian area. I exchanged out
for a new sterile gown and new sterile gloves. Using 1% Xylocaine, we
anesthetized the left subclavian area in the subcutaneous tissue over the old
permanent pacemaker pulse generator. Using a scalpel, a 4 cm horizontal
incision was then made into the subclavian area over the old permanent
pacemaker pulse generator. The pacemaker capsule was then entered.
Utilizing a curved hemostat, I was able to dissect out the old permanent
pacemaker pulse generator from the pacemaker capsule. The old permanent
pacemaker pulse generator was then brought out to the surface of the skin.
We then disconnected both leads from the old permanent pacemaker pulse
generator. We checked thresholds on both leads. From the atrial lead they
were as follows:
1. Voltage 0.4 volts.
2. P wave 4.1 millivolts.
3. Resistance 513 ohms.
These thresholds in the atrial lead were thought to be quite good, especially
for chronic thresholds. I then checked the thresholds on the ventricular
lead. They were as follows:
1. Voltage 0.7 volts.
2. R wave 8.5 millivolts.
3. Resistance 972 ohms.
These thresholds were also thought to be quite good with regards to the
ventricular lead as well. We then irrigated out the pacemaker pocket very
vigorously with antibiotic solution. I took a piece of 4 x 4 gauze and
saturated it with antibiotic solution. I then proceeded to wipe down both
pacemaker leads very carefully as well as then new permanent pacemaker pulse
generator. We connected the new permanent pacemaker pulse generator to both
leads. I documented adequate capture in both leads. We then used the
sterile programming head in order to program the new permanent pacemaker
pulse generator. During this time, the new permanent pacemaker pulse
generator and excess pacemaker leads were placed in the pacemaker pocket.
The subcutaneous tissue was closed in an interrupted layer of 2-0 Vicryl
suture. The skin was then closed with staples. During this time, the
temporary pacemaker leads was removed under fluoroscopy without difficulty.
The explanted pacemaker was a Medtronic, model #KDR901. The new permanent
pacemaker pulse generator is a Medtronic Versa, model #VEDR01, serial
#NWH223704H. The pacemaker is set in the DDD mode at a lower rate of 60 and
upper rate of 120 beats per minute. Both chambers were set at nominal
settings. Both leads were set in a bipolar configuration.
CONCLUSION
1. Successful DDDR permanent pacemaker battery change out.
2. Successful insertion of a transvenous temporary ventricular pacemaker
via the right femoral vein.