jbhansen
Networker
Does anyone have any suggestions or guidance as to whether the following should be coded as a temporary pacemaker (33210) or a permanent pacemaker (33216? lead only since generator was not implanted, just hooked up and left external to the body)? TIA!
We have recommended a temporary ventricular pacemaker. It is anticipated that she will be hospitalized for a number of days while her medical problems are being addressed and therefore, we are recommending a "permanent" pacemaker lead with an externalized permanent pacemaker generator.
PROCEDURE: Informed consent was obtained. The left IJ area was prepped and draped. Access to the left internal jugular vein was obtained twice and guidewires were inserted. Over one of the guidewires, a triple-lumen catheter was inserted into the SVC and secured with 2-0 silk. Over the second guidewire, a 7-French peel-away sheath was inserted. Through it, a Boston Scientific, model 4471, pacing lead was advanced to the right ventricle. Several RV sites were tried and the lead was screwed into each one. Initially capture threshold at 0.5 milliseconds pulse was elevated at approximately 3.5 volts. We finally settled for a site at or near the RV apex with a similar threshold. At one millisecond, capture threshold was 2.8 volts. Sensed R-wave amplitude was 7.9 millivolts and pacing impedance was 453 ohms.
The lead was secured at the skin entry site with 3-0 Mersilene sutures on the suture sleeve. A sterile dressing was placed on the right IJ site. A nonsterile Boston Scientific dual-chamber pacemaker was attached to the lead (model K174). The generator was secured to the chest wall with a Tegaderm adhesive. Thresholds were confirmed through the generator.
We have recommended a temporary ventricular pacemaker. It is anticipated that she will be hospitalized for a number of days while her medical problems are being addressed and therefore, we are recommending a "permanent" pacemaker lead with an externalized permanent pacemaker generator.
PROCEDURE: Informed consent was obtained. The left IJ area was prepped and draped. Access to the left internal jugular vein was obtained twice and guidewires were inserted. Over one of the guidewires, a triple-lumen catheter was inserted into the SVC and secured with 2-0 silk. Over the second guidewire, a 7-French peel-away sheath was inserted. Through it, a Boston Scientific, model 4471, pacing lead was advanced to the right ventricle. Several RV sites were tried and the lead was screwed into each one. Initially capture threshold at 0.5 milliseconds pulse was elevated at approximately 3.5 volts. We finally settled for a site at or near the RV apex with a similar threshold. At one millisecond, capture threshold was 2.8 volts. Sensed R-wave amplitude was 7.9 millivolts and pacing impedance was 453 ohms.
The lead was secured at the skin entry site with 3-0 Mersilene sutures on the suture sleeve. A sterile dressing was placed on the right IJ site. A nonsterile Boston Scientific dual-chamber pacemaker was attached to the lead (model K174). The generator was secured to the chest wall with a Tegaderm adhesive. Thresholds were confirmed through the generator.