deeva456
Expert
How would you code this? I coded it as 33210 but the EP physician is asking to bill with 33216. The electrophysiologist "was told" by other EP physicians to bill with 33216. However the lead was connected to an external PM generator. The patient will be wearing this for more than 2 weeks while waiting for an infection to clear up.
Preoperative diagnosis / indication: Complete heart block in shock status
Postoperative diagnosis: The same as above with successful device implant
Procedure:
· Sedation by anesthesiologist.
· Semi-permanent pacemaker implant, transvenous, right jugular vein, with right ventricular lead, 33216.
· Fluoroscopy
Consent:
Informed consent was obtained (see my clinical notes for details).
Methods:
· Pre-procedure
Patient was brought to EP suite and placed onto the procedure table and monitored for blood pressure, EKG tracings, and pulse oximetry in a routine way. Transcutaneous pacing and defibrillation pads were set up in a routine way.
Prophylactic antibiotic: ancef. . The neck was prepared with sterile techniques. Sedation was initiated.
· Device implant
The patient had asystole requiring transcutaneous pacing during part of the procedure.
The patient was draped in a sterile fashion. Access to the right jugular vein was obtained using a modified Seldinger technique with US. guidance. RV lead was placed in the RV with active fixation through sheath, tested with appropriate parameters with no phrenic nerve or diaphragmatic stimulation using 10 V pacing, secured with sleeve to skin with 0 sutures at venous entry site, and attached to external pacemaker generator. The lead was also secured to skin with sterile tapes and dressings in a routine way. Post procedure fluoroscope showed normal heart wall motion.
· Post-implant
The patient tolerated the procedure well, with no immediate complications. The patient was transferred out for further observation and monitoring.
The patient received appropriate procedural sedation throughout the procedure. For medication and other details, please refer to nurse medication summary and nurse note.
Complications: no immediate EBL: < 10 ml Fluoroscope time: < 3 min
Medications: See nurse lot. Contrast: 0 ml
Summary: Successful implantation of semi-permanent pacemaker without acute complications.
Thank you
Dolores
Preoperative diagnosis / indication: Complete heart block in shock status
Postoperative diagnosis: The same as above with successful device implant
Procedure:
· Sedation by anesthesiologist.
· Semi-permanent pacemaker implant, transvenous, right jugular vein, with right ventricular lead, 33216.
· Fluoroscopy
Consent:
Informed consent was obtained (see my clinical notes for details).
Methods:
· Pre-procedure
Patient was brought to EP suite and placed onto the procedure table and monitored for blood pressure, EKG tracings, and pulse oximetry in a routine way. Transcutaneous pacing and defibrillation pads were set up in a routine way.
Prophylactic antibiotic: ancef. . The neck was prepared with sterile techniques. Sedation was initiated.
· Device implant
The patient had asystole requiring transcutaneous pacing during part of the procedure.
The patient was draped in a sterile fashion. Access to the right jugular vein was obtained using a modified Seldinger technique with US. guidance. RV lead was placed in the RV with active fixation through sheath, tested with appropriate parameters with no phrenic nerve or diaphragmatic stimulation using 10 V pacing, secured with sleeve to skin with 0 sutures at venous entry site, and attached to external pacemaker generator. The lead was also secured to skin with sterile tapes and dressings in a routine way. Post procedure fluoroscope showed normal heart wall motion.
· Post-implant
The patient tolerated the procedure well, with no immediate complications. The patient was transferred out for further observation and monitoring.
The patient received appropriate procedural sedation throughout the procedure. For medication and other details, please refer to nurse medication summary and nurse note.
Complications: no immediate EBL: < 10 ml Fluoroscope time: < 3 min
Medications: See nurse lot. Contrast: 0 ml
Summary: Successful implantation of semi-permanent pacemaker without acute complications.
Thank you
Dolores