spielmar
New
I am in desperate need of some help with this procedure code please! Ok, at first I coded this as 33228. Reviewed documentation again. I corrected charge lines to include 33233 for the removal of the pacemaker, no leads were removed. I added the charge for the attempted insertion 33249-53 of the ICD. But now I see that this is incorrect as well. I'm so confused now. I don't know how I would code this. Would I just code the revision?
Newly identified ischemic cardiomyopathy, previous pacemaker for sick sinus syndrome, intermittent AV block presents for dual-chamber pacemaker upgrade to dual-chamber ICD for primary prevention sudden cardiac death despite the use of goal-directed medical therapy with no improvement in ejection fraction.
Procedures
1. Attempted RV ICD lead implantation
2. Device Interrogation
3. TYRX pouch
4. Conscious sedation
5. Pacemaker pocket revision
After the patient gave informed written consent, they were brought to the EP lab
in a fasting non-sedated state. After appropriate antiseptic prep, peri-
operative antibiotics infusing and using local anesthesia, cutdown to the
deltopectoral fascia was performed using blunt dissection and electrocautery at
the site of previous scar. Old generator and leads were freed from adhesions
with careful dissection by electrocautery. Generator was taken out of pocket.
Left upper extremity venogram was done with high suspicious for total occlusion of left subclavian vein however there appeared to be a microchannel and multiple attempts were made to cannulate this channel. On repeat imaging at a more caudal projection, what appeared to be microchannel ended up being a collateral which could not be cannulated and accessed after multiple attempts.
Hence given patient age, safety of his chronic leads, risk of pneumothorax on multiple accesses, decision was made to close the case without having being able to successfully upgrade his device. Pacemaker pocket however was extended inferiorly and medially for a better position and hence pocket revision was done.
Leads were connected to the old generator and cleaned with wet and dry sponges.
The generator was placed in pocket with TYRX puch and the pocket was irrigated with antibiotic/saline solution.
The pocket was closed with multiple layers of absorbable suture and steri-strips
with a sterile dressing were applied.
Postprocedure testing revealed baseline sensing impedances and thresholds.
Complications: None
Newly identified ischemic cardiomyopathy, previous pacemaker for sick sinus syndrome, intermittent AV block presents for dual-chamber pacemaker upgrade to dual-chamber ICD for primary prevention sudden cardiac death despite the use of goal-directed medical therapy with no improvement in ejection fraction.
Procedures
1. Attempted RV ICD lead implantation
2. Device Interrogation
3. TYRX pouch
4. Conscious sedation
5. Pacemaker pocket revision
After the patient gave informed written consent, they were brought to the EP lab
in a fasting non-sedated state. After appropriate antiseptic prep, peri-
operative antibiotics infusing and using local anesthesia, cutdown to the
deltopectoral fascia was performed using blunt dissection and electrocautery at
the site of previous scar. Old generator and leads were freed from adhesions
with careful dissection by electrocautery. Generator was taken out of pocket.
Left upper extremity venogram was done with high suspicious for total occlusion of left subclavian vein however there appeared to be a microchannel and multiple attempts were made to cannulate this channel. On repeat imaging at a more caudal projection, what appeared to be microchannel ended up being a collateral which could not be cannulated and accessed after multiple attempts.
Hence given patient age, safety of his chronic leads, risk of pneumothorax on multiple accesses, decision was made to close the case without having being able to successfully upgrade his device. Pacemaker pocket however was extended inferiorly and medially for a better position and hence pocket revision was done.
Leads were connected to the old generator and cleaned with wet and dry sponges.
The generator was placed in pocket with TYRX puch and the pocket was irrigated with antibiotic/saline solution.
The pocket was closed with multiple layers of absorbable suture and steri-strips
with a sterile dressing were applied.
Postprocedure testing revealed baseline sensing impedances and thresholds.
Complications: None