lcouto
Networker
Not sure how to bill this... Would it be 33210 and 33215?
Pre-procedure Diagnoses
1. Pacemaker lead malfunction, initial encounter
Post-procedure Diagnoses
1. Pacemaker lead malfunction, initial encounter
Procedures
1. LEAD REVISION
2. TEMPORARY PACEMAKER INSERTION
BRIEF OPERATIVE NOTE
Pre-operative Diagnosis:
Pacemaker lead malfunction, initial encounter
Post-operative Diagnosis:
Same as above
Procedure Performed :
TEMPORARY PACEMAKER INSERTION
Lead revision
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.
2% lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the right common femoral vein. Percutaneous access was obtained utilizing a modified self technique with placement of 5 French venous catheter. Under fluoroscopic guidance a 5 French Bard pacing lead was advanced into the right ventricular apex. Pacemaker was tested and adequate backup pacing parameters were programmed.
Lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the left pectoralis muscle. Sharp incision was made in the skin. Utilizing a combination of sharp and blunt dissection, the old pulse generator was carefully dissected from its pocket in the prepectoral fascia.
The ventricular lead was disconnected. A stylette was advanced and the pacing screw was retracted. Utilizing a combination of curved and straight stylette's, the ventricular lead was repositioned in the high left ventricular septum. It was tested and found to have R waves of 0 mV, impedance 722 ohms, threshold was 0.6 volts, current 0.9 milliamps. The atrial lead was an active fixation lead. The ventricular lead was reconnected.The leads and pulse generator were incorporated in the pocket. The pocket was copiously irrigated with antibiotic solution. The subcutaneous fascia was closed with interrupted 3-0 Vicryl suture. The skin layer was closed with a running subcuticular 4-0 Vicryl stitch followed by surgical adhesive and steristrips. The wound was dressed in a sterile fashion.
Pre-procedure Diagnoses
1. Pacemaker lead malfunction, initial encounter
Post-procedure Diagnoses
1. Pacemaker lead malfunction, initial encounter
Procedures
1. LEAD REVISION
2. TEMPORARY PACEMAKER INSERTION
BRIEF OPERATIVE NOTE
Pre-operative Diagnosis:
Pacemaker lead malfunction, initial encounter
Post-operative Diagnosis:
Same as above
Procedure Performed :
TEMPORARY PACEMAKER INSERTION
Lead revision
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.
2% lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the right common femoral vein. Percutaneous access was obtained utilizing a modified self technique with placement of 5 French venous catheter. Under fluoroscopic guidance a 5 French Bard pacing lead was advanced into the right ventricular apex. Pacemaker was tested and adequate backup pacing parameters were programmed.
Lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the left pectoralis muscle. Sharp incision was made in the skin. Utilizing a combination of sharp and blunt dissection, the old pulse generator was carefully dissected from its pocket in the prepectoral fascia.
The ventricular lead was disconnected. A stylette was advanced and the pacing screw was retracted. Utilizing a combination of curved and straight stylette's, the ventricular lead was repositioned in the high left ventricular septum. It was tested and found to have R waves of 0 mV, impedance 722 ohms, threshold was 0.6 volts, current 0.9 milliamps. The atrial lead was an active fixation lead. The ventricular lead was reconnected.The leads and pulse generator were incorporated in the pocket. The pocket was copiously irrigated with antibiotic solution. The subcutaneous fascia was closed with interrupted 3-0 Vicryl suture. The skin layer was closed with a running subcuticular 4-0 Vicryl stitch followed by surgical adhesive and steristrips. The wound was dressed in a sterile fashion.