Wiki pacemaker

[bennieyoung]

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.

 

[Margaret Morgan]

I'm a little confused as where the 2 epicardial leads were placed, LV only???? but based on the dx, I can only assume they were placed for LV and not either RV/RA pacing. So based on the limit info (and I would query your MD) I code this an epicardial lead placement, 33202 and was going to say generator exchange but it doesn't state the old PPM generator was removed, only the pocket was revised, so 33221 for Biv PPM generator placement. I would query your physician on the pocket, was the old PPM generator removed, if so, addend and bill 33229 instead. I would not bill for 32100 as it is global to 33202 in my opinion.

 

[bennieyoung]

I'm a little confused as where the 2 epicardial leads were placed, LV only???? but based on the dx, I can only assume they were placed for LV and not either RV/RA pacing. So based on the limit info (and I would query your MD) I code this an epicardial lead placement, 33202 and was going to say generator exchange but it doesn't state the old PPM generator was removed, only the pocket was revised, so 33221 for Biv PPM generator placement. I would query your physician on the pocket, was the old PPM generator removed, if so, addend and bill 33229 instead. I would not bill for 32100 as it is global to 33202 in my opinion.

Thank you so much for your response. I have sent a query to my physician as you suggested. I was confused by this one as well.