Our dr. preformed a:
Upgrade of a bi-ventricular pacemaker to a bi-ventricular implantable cardioverter defib.
Implantation of a new "right" ventricular defib lead
Extraction of the pre-existing right ventricular pacemaker lead
pocket revision
The pocket was opened using sharp and blunt dissection. The pacemaker pocket was quite superficial on the pocket that was above the pectoralis muscle. The patient had lost significant weight, therefore it was decided to perform a pocket revision and create a new pocket on a subpectoral plane.
The pre-existing biventricular pacemaker was dissected from the surrounding tissue. The capsule was excised. The device was removed from the pocket. The device was disconnected from the leads and removed from the surgical field.
We advanced a long 9-french peel away sheath over the long wire into the right atrium.
We implanted a single coil ICD lead in the mid RV septum. The lead was secured to the underlying muscle using a 0-silk suture.
We advanced a stylet inside the pre-existing right ventricular pacemaker lead and decided to extract that. The helix was retracted. With manual pressure, the lead was successfully extracted in its entirety.
We tested the pre-existing atrial and left ventricular leads. The patirnet was initially in atrial flutter with a very slow cycle length of about 380 milliseconds. Using a burst atrial pacing, we stopped the atrial flutter.
We tested the pre-existing left ventricular lead which is a st jude.
The atrial, right ventricular lead, and left ventricular leads were connected to a new bi-ventricular ICD generator.
We dissected using sharp and blunt dissection, created a new pocket on a subpectoral plane underneath the pectoralis muscle.
Defibrillator threshold testing was performed. Ventricular fib was induced using shock on the T-wave. The device was successfully detected and terminated the arrhythmia.
I am not sure what codes to use. What is confusing for me is the conversion from the bi to bi but also the removal and replace (def lead) of RV lead.
Thanks for looking
Upgrade of a bi-ventricular pacemaker to a bi-ventricular implantable cardioverter defib.
Implantation of a new "right" ventricular defib lead
Extraction of the pre-existing right ventricular pacemaker lead
pocket revision
The pocket was opened using sharp and blunt dissection. The pacemaker pocket was quite superficial on the pocket that was above the pectoralis muscle. The patient had lost significant weight, therefore it was decided to perform a pocket revision and create a new pocket on a subpectoral plane.
The pre-existing biventricular pacemaker was dissected from the surrounding tissue. The capsule was excised. The device was removed from the pocket. The device was disconnected from the leads and removed from the surgical field.
We advanced a long 9-french peel away sheath over the long wire into the right atrium.
We implanted a single coil ICD lead in the mid RV septum. The lead was secured to the underlying muscle using a 0-silk suture.
We advanced a stylet inside the pre-existing right ventricular pacemaker lead and decided to extract that. The helix was retracted. With manual pressure, the lead was successfully extracted in its entirety.
We tested the pre-existing atrial and left ventricular leads. The patirnet was initially in atrial flutter with a very slow cycle length of about 380 milliseconds. Using a burst atrial pacing, we stopped the atrial flutter.
We tested the pre-existing left ventricular lead which is a st jude.
The atrial, right ventricular lead, and left ventricular leads were connected to a new bi-ventricular ICD generator.
We dissected using sharp and blunt dissection, created a new pocket on a subpectoral plane underneath the pectoralis muscle.
Defibrillator threshold testing was performed. Ventricular fib was induced using shock on the T-wave. The device was successfully detected and terminated the arrhythmia.
I am not sure what codes to use. What is confusing for me is the conversion from the bi to bi but also the removal and replace (def lead) of RV lead.
Thanks for looking