bennieyoung
Guru
We have a denial for using code 32100 code as incidental to primary code. I coded 32100, 33213, 33202.
Anyone available to look at this and share your thoughts with me?
PREOPERATIVE DIAGNOSIS: Inaccessible coronary sinus for left ventricular lead placement due to multiple previous pacemaker leads.
POSTOPERATIVE DIAGNOSIS: Inaccessible coronary sinus for left ventricular lead placement due to multiple previous pacemaker leads.
PROCEDURE PERFORMED:
1. Left minithoracotomy, non-rib spreading with placement of 2 epicardial leads tunneled to the right side. Pacemaker in the clavicular position.
2. Replacement of pacemaker with revision of pacemaker pocket.
FINDINGS:
DESCRIPTION OF PROCEDURE: Under general anesthetic, the entire chest was prepped and draped in sterile classical manner. The 4th intercostal space incision was made. A retractor was placed with minimal retraction on the ribs. The pericardium was opened. The lateral wall of the left ventricle was identified and 2 epicardial leads were secured in place. A single chest tube was placed in the pleural cavity and that cavity was closed. We then tunneled the leads across the anterior chest wall to the left pacemaker which had been previously placed. This was exposed. The pacemaker pocket was revised, producing a subpectoral pocket because of the patient's very thin skin and subcutaneous tissue. The new device was secured to the chest wall. The muscle was closed over the pacemaker and the additional LV lead that had been placed. Skin and subcu were closed. 0.25% Marcaine was used to infiltrate the incisions as well as the intercostal space. Dressings were applied. Patient was returned to recovery room in stable condition.
Anyone available to look at this and share your thoughts with me?
PREOPERATIVE DIAGNOSIS: Inaccessible coronary sinus for left ventricular lead placement due to multiple previous pacemaker leads.
POSTOPERATIVE DIAGNOSIS: Inaccessible coronary sinus for left ventricular lead placement due to multiple previous pacemaker leads.
PROCEDURE PERFORMED:
1. Left minithoracotomy, non-rib spreading with placement of 2 epicardial leads tunneled to the right side. Pacemaker in the clavicular position.
2. Replacement of pacemaker with revision of pacemaker pocket.
FINDINGS:
DESCRIPTION OF PROCEDURE: Under general anesthetic, the entire chest was prepped and draped in sterile classical manner. The 4th intercostal space incision was made. A retractor was placed with minimal retraction on the ribs. The pericardium was opened. The lateral wall of the left ventricle was identified and 2 epicardial leads were secured in place. A single chest tube was placed in the pleural cavity and that cavity was closed. We then tunneled the leads across the anterior chest wall to the left pacemaker which had been previously placed. This was exposed. The pacemaker pocket was revised, producing a subpectoral pocket because of the patient's very thin skin and subcutaneous tissue. The new device was secured to the chest wall. The muscle was closed over the pacemaker and the additional LV lead that had been placed. Skin and subcu were closed. 0.25% Marcaine was used to infiltrate the incisions as well as the intercostal space. Dressings were applied. Patient was returned to recovery room in stable condition.