Wiki unsuccessful lv lead revision need help coding

bhargavi

Guru
Messages
152
Location
Middletown, DE
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Conclusion

Cardiac BiV ICD LV lead explant and attempted reimplant Operative Report
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Procedure(s): BiV ICD LV Lead explant and attempted reimplantation
L SC Vein veinogram 10 cc showing occluded L subclavian vein
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Indications: LV lead dislodgment
LBBB
Chronic ssytolic CHF FC III
Cardiomyopathy, Nonischemic Dilated
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Hardware Implanted:
## Not MRI COMPATIBLE SYSTEM Due to plugged LV port ##
None
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Hardware Explanted: LV quadrapolar lead MN 1458Q-86 SN Bpp161787 implanted 4/17/18
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Hardware Added:
LV port plug MN ACIS4PP, SN 9442638
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Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was marked and timeout done.
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The antibiotic was completely infused. The patient was prepped and draped in the usual sterile fashion. The right femoral region was anesthetized with 10 cc of 2% lidocaine and a 6 f sheath placed and a 6 f quadrapolar catheter was inserted into the CS.
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The left upper chest anesthetized with 10 cc of 50/50 mixture of 0.25% marcaine and 2% lidocaine. An incision was made in the deltopectoral groove and electrocautery used to perform dissection down to the device pocket where the pocket was incised, device delivered, and the LV lead removed from the header. The LV tiedown was freed, and the LV lead easily pulled out. SC puncture was unsuccessful and axillary vein was performed successfully. Veinogram of 10 cc contrast through L arm IV showed the SC vein to be occluded with collaterals directing to the L IJ vein which reconstituted the L SC vein distally. A wire and sheath were used to attempt to dissect throught the occluded SC vein without success. The LV port was plugged. The old leads remained secured to the old device and placed into the pocket after irrigation with an antibiotic solution and hemostasis.
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DFT testing was not performed.
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The incision was closed in 3 layers, the lower two with running 2-0 Vicryl and the cutaneous with 4-0 Vicryl. Steri-Strips and a dry sterile dressing were placed over the wound and the patient was transferred to the PACU in stable condition for recovery from anesthesia.
thanks in advance
should I code 33225-74? but 33225 will need primary code? or should I just code 75820?
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