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Does any one know how to bill for a rt atrial and rt ventricle leads repositioning, I know that you use 33215 for either or but not for sure how to bill repositioning of both leads?
PROCEDURE PERFORMED: Atrial and ventricular lead revision under
fluoroscopy.
INDICATIONS: Recent pacemaker insertion with interrogation showing the
ventricular lead from apparently retracted into the atrium.
DESCRIPTION OF PROCEDURE: Informed consent was obtained for the
above-mentioned procedure. The patient was given intravenous Versed and
Sublimaze. He was given intravenous Ancef. Using sterile technique and
lidocaine anesthesia, I dissected out the old pacemaker. The leads had
developed significant fibrosis and required prolonged and careful dissection
to dissect out the leads. Under fluoroscopy, the atrial lead appeared to
have retracted in the ventricular lead appeared to be in the ventricle, but
may have been in the coronary sinus; however, interrogation revealed atrial
pacing, so this may have actually been in the coronary sinus. I withdrew
the ventricular lead from the current position and placed in the apex of the
right ventricle and I advanced the atrial lead so that it was well within
the right atrial appendage. I rechecked the numbers and in the atrium, the
P-wave sensing was 2.6 millivolts, threshold to capture 0.4 volts, impedance
540 ohms. In the ventricle, R-wave sensing was 11.6 millivolts, impedance
654 ohms, sensing and capture 0.4 volts. I placed the original pulse
generator back in the pocket and put _____ around the lead with 0 silk,
irrigated with antibiotic solution and closed with 3-0 undyed Vicryl.
Steri-Strips were applied. Blood loss estimated to be approximately 10 mL.
Fluoroscopy confirmed in good position and the patient left the
catheterization lab in stable condition.
PROCEDURE PERFORMED: Atrial and ventricular lead revision under
fluoroscopy.
INDICATIONS: Recent pacemaker insertion with interrogation showing the
ventricular lead from apparently retracted into the atrium.
DESCRIPTION OF PROCEDURE: Informed consent was obtained for the
above-mentioned procedure. The patient was given intravenous Versed and
Sublimaze. He was given intravenous Ancef. Using sterile technique and
lidocaine anesthesia, I dissected out the old pacemaker. The leads had
developed significant fibrosis and required prolonged and careful dissection
to dissect out the leads. Under fluoroscopy, the atrial lead appeared to
have retracted in the ventricular lead appeared to be in the ventricle, but
may have been in the coronary sinus; however, interrogation revealed atrial
pacing, so this may have actually been in the coronary sinus. I withdrew
the ventricular lead from the current position and placed in the apex of the
right ventricle and I advanced the atrial lead so that it was well within
the right atrial appendage. I rechecked the numbers and in the atrium, the
P-wave sensing was 2.6 millivolts, threshold to capture 0.4 volts, impedance
540 ohms. In the ventricle, R-wave sensing was 11.6 millivolts, impedance
654 ohms, sensing and capture 0.4 volts. I placed the original pulse
generator back in the pocket and put _____ around the lead with 0 silk,
irrigated with antibiotic solution and closed with 3-0 undyed Vicryl.
Steri-Strips were applied. Blood loss estimated to be approximately 10 mL.
Fluoroscopy confirmed in good position and the patient left the
catheterization lab in stable condition.
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