lcouto
Networker
My doctor did a dual pacer insertion on 2/25 and then the patient had to go back in 3/7 for a Ventricular lead revision for Pacemaker lead malfunction, not sure how to code the lead revision....help please...
Thanks,
Lisa
Here is a copy of the report
Pre-procedure Diagnoses
1. Pacemaker lead malfunction
Post-procedure Diagnoses
1. Pacemaker lead malfunction
BRIEF OPERATIVE NOTE
Date of Surgery:
3/7/2013
Pre-operative Diagnosis:
Pacemaker lead malfunction
Post-operative Diagnosis:
Same as above
Procedure Performed :
Ventricular lead revision
Anesthesia:
Moderate Conscious Sedation
Total IV Fluids & Blood loss;
Minimal blood loss
Implants and Procedure Description:
After informed consent was obtained, the patient was transported in a nonsedated condition to the cardiac catheterization suite. The patient was given moderate conscious sedation. The patient was prepped and draped in a sterile fashion and a "timeout" was taken.
ACCESS and POCKET FORMATION:
Lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the left pectoralis muscle. Sharp incision was made in the skin through the previous pacemaker scar line. Utilizing a combination of sharp and blunt dissection, the pocket was opened and the pacemaker explanted.
Utilizing curved and straight stylettes, the ventricular lead was repositioned and secured in the right ventricular septal wall apex. It was tested and found to have R waves of 8.7 mV, impedance 853 ohms, threshold was 0.4 volts, current 0.5 milliamps. Adequate slack was placed in the lead under fluoroscopic guidance. The lead was tested with output of 10 V and did not stimulate the diaphragm. The ventricular lead was then secured to the pectoralis muscle with non-resorbable suture. I then reattached the pulse generator. The leads and pulse generator were incorporated in the pocket. The pocket was copiously irrigated. The subcutaneous fascia was closed with interrupted Vicryl suture. The skin layer was closed with a subcuticular Vicryl stitch. Final fluoroscopy demonstrated adequate slack in the leads. The wound was dressed in a sterile fashion.
Thanks,
Lisa
Here is a copy of the report
Pre-procedure Diagnoses
1. Pacemaker lead malfunction
Post-procedure Diagnoses
1. Pacemaker lead malfunction
BRIEF OPERATIVE NOTE
Date of Surgery:
3/7/2013
Pre-operative Diagnosis:
Pacemaker lead malfunction
Post-operative Diagnosis:
Same as above
Procedure Performed :
Ventricular lead revision
Anesthesia:
Moderate Conscious Sedation
Total IV Fluids & Blood loss;
Minimal blood loss
Implants and Procedure Description:
After informed consent was obtained, the patient was transported in a nonsedated condition to the cardiac catheterization suite. The patient was given moderate conscious sedation. The patient was prepped and draped in a sterile fashion and a "timeout" was taken.
ACCESS and POCKET FORMATION:
Lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the left pectoralis muscle. Sharp incision was made in the skin through the previous pacemaker scar line. Utilizing a combination of sharp and blunt dissection, the pocket was opened and the pacemaker explanted.
Utilizing curved and straight stylettes, the ventricular lead was repositioned and secured in the right ventricular septal wall apex. It was tested and found to have R waves of 8.7 mV, impedance 853 ohms, threshold was 0.4 volts, current 0.5 milliamps. Adequate slack was placed in the lead under fluoroscopic guidance. The lead was tested with output of 10 V and did not stimulate the diaphragm. The ventricular lead was then secured to the pectoralis muscle with non-resorbable suture. I then reattached the pulse generator. The leads and pulse generator were incorporated in the pocket. The pocket was copiously irrigated. The subcutaneous fascia was closed with interrupted Vicryl suture. The skin layer was closed with a subcuticular Vicryl stitch. Final fluoroscopy demonstrated adequate slack in the leads. The wound was dressed in a sterile fashion.
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