TanyaJ
New
When I see cardiac cases I always second guess myself. Any feedback would be appreciated! Here's the brief Op Note:
DESCRIPTION OF TECHNIQUE: After informed consent, the patient was taken to the OR. The upper chest was prepped and draped in the usual sterile fashion. Lidocaine 1% and 0.25% Marcaine were used as local anesthesia. A 6 cm incision was made one fingerbreadth below the angle of the clavicle and carried down to the pectoralis fascia using electrocautery. A generator pocket was created in the tissue anterior to the pectoralis muscle. Using a micropuncture kit, the left subclavian vein was cannulated and a short J guidewire inserted under fluoroscopic guidance. A 9-French sheath was inserted and used to pass a defibrillator lead to the RV apex (Boston Scientific model 0292, serial number 127796). This lead had a pacing threshold of 0.8 volts with an impedance of 989 ohms. The R wave was 11 mV. The lead was secured with 2-0 Ethibond stitches each and connected to the pulse generator (Boston Scientific model E160, serial number 107656). The pulse generator was secured with an 0 Ethibond stitch.
The pocket was irrigated antibiotic solution. The generator was anchored with a single 0 Ethibond stitch. The wound was closed with a deep layer of 3-0 Vicryl and a subcuticular layer of 4-0 Vicryl. Steri-Strips and a dressing were applied. The patient was returned to her room in stable condition.
My question is would you still use 33249 (which crosses over to ASA code 00537) even though there doesn't seem to be any testing of the device? Or would you go out on your own and use 00534?
DESCRIPTION OF TECHNIQUE: After informed consent, the patient was taken to the OR. The upper chest was prepped and draped in the usual sterile fashion. Lidocaine 1% and 0.25% Marcaine were used as local anesthesia. A 6 cm incision was made one fingerbreadth below the angle of the clavicle and carried down to the pectoralis fascia using electrocautery. A generator pocket was created in the tissue anterior to the pectoralis muscle. Using a micropuncture kit, the left subclavian vein was cannulated and a short J guidewire inserted under fluoroscopic guidance. A 9-French sheath was inserted and used to pass a defibrillator lead to the RV apex (Boston Scientific model 0292, serial number 127796). This lead had a pacing threshold of 0.8 volts with an impedance of 989 ohms. The R wave was 11 mV. The lead was secured with 2-0 Ethibond stitches each and connected to the pulse generator (Boston Scientific model E160, serial number 107656). The pulse generator was secured with an 0 Ethibond stitch.
The pocket was irrigated antibiotic solution. The generator was anchored with a single 0 Ethibond stitch. The wound was closed with a deep layer of 3-0 Vicryl and a subcuticular layer of 4-0 Vicryl. Steri-Strips and a dressing were applied. The patient was returned to her room in stable condition.
My question is would you still use 33249 (which crosses over to ASA code 00537) even though there doesn't seem to be any testing of the device? Or would you go out on your own and use 00534?