bhargavi
Guru
since the physician did repositioning ra and rv lead should I bill 33215 twice? and is there a modifier? patient was brought back to cath lab within 4 days of original placement of pacemaker.
thanks in advance
Procedures
Ra Lead Revision
Rv Lead Revision
Link to Procedure Log
Procedure Log
Indications
Complication associated with cardiac pacemaker lead, initial encounter [T82.9XXA (ICD-10-CM)]
SSS (sick sinus syndrome) [I49.5 (ICD-10-CM)]
Syncope, unspecified syncope type [R55 (ICD-10-CM)]
Conclusion
DDDR Cardiac Pacemaker Lead Revision Operative Report
*
*
Procedure(s): Dual Chamber Permanent Pacemaker A and V lead revision; Cardiac Fluoroscopy
*
Indications:
A lead perforation
SSS
PAF
Syncope
*
Hardware Implanted:
None
*
Hardware explanted:
None. A lead removed and reinserted.
*
Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was marked and timeout done.
*
The antibiotic was completely infused. The patient was prepped and draped in the usual sterile fashion and the left upper chest was anesthetized with 20 cc of 50/50 mixture of 0.25% marcaine and 2% lidocaine. An incision was made over the old incision, and the pocket was opened and the PG delivered. The atrial lead was freed from the device and the tie down, and atrial fibrillation was present. The atrial lead active fixation was withdrawn and the lead pulled back to the SVC without event. The A lead was tight and unable to be manipulated so an axillary vein stick created new access and the A lead placed into the RA appendage. The patient was now in atrial flutter. The V lead was freed due to appearance of possible tunneling and repositioned on the septum. Both leads were anchored to the pectoralis fascial using 0 Ethibond. Pacing and sensing thresholds were obtained.
*
The leads were secured to the device and placed in the pocket after irrigation with an antibiotic solution and hemostasis. Incision was closed in 3 layers, the lower two with running 2-0 Vicryl and the cutaneous with 4-0 Vicryl. Steri-Strips and a dry sterile dressing were placed over the wound and the patient was transferred to the PACU in stable condition for recovery from anesthesia
thanks in advance
Procedures
Ra Lead Revision
Rv Lead Revision
Link to Procedure Log
Procedure Log
Indications
Complication associated with cardiac pacemaker lead, initial encounter [T82.9XXA (ICD-10-CM)]
SSS (sick sinus syndrome) [I49.5 (ICD-10-CM)]
Syncope, unspecified syncope type [R55 (ICD-10-CM)]
Conclusion
DDDR Cardiac Pacemaker Lead Revision Operative Report
*
*
Procedure(s): Dual Chamber Permanent Pacemaker A and V lead revision; Cardiac Fluoroscopy
*
Indications:
A lead perforation
SSS
PAF
Syncope
*
Hardware Implanted:
None
*
Hardware explanted:
None. A lead removed and reinserted.
*
Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was marked and timeout done.
*
The antibiotic was completely infused. The patient was prepped and draped in the usual sterile fashion and the left upper chest was anesthetized with 20 cc of 50/50 mixture of 0.25% marcaine and 2% lidocaine. An incision was made over the old incision, and the pocket was opened and the PG delivered. The atrial lead was freed from the device and the tie down, and atrial fibrillation was present. The atrial lead active fixation was withdrawn and the lead pulled back to the SVC without event. The A lead was tight and unable to be manipulated so an axillary vein stick created new access and the A lead placed into the RA appendage. The patient was now in atrial flutter. The V lead was freed due to appearance of possible tunneling and repositioned on the septum. Both leads were anchored to the pectoralis fascial using 0 Ethibond. Pacing and sensing thresholds were obtained.
*
The leads were secured to the device and placed in the pocket after irrigation with an antibiotic solution and hemostasis. Incision was closed in 3 layers, the lower two with running 2-0 Vicryl and the cutaneous with 4-0 Vicryl. Steri-Strips and a dry sterile dressing were placed over the wound and the patient was transferred to the PACU in stable condition for recovery from anesthesia