Wiki Upgrade of dual-chamber ICD to biventricular ICD.

[calorom2]

I have never coded one of these...can someone give me some input/guidance?

Thank you!

PROCEDURE PERFORMED:
Upgrade of dual-chamber ICD to biventricular ICD.

PREOPERATIVE DIAGNOSIS:
Chronic systolic heart failure. Chronic RV pacing. Ejection fraction
less than 30%.

ANESTHESIA:
General.

ESTIMATED BLOOD LOSS:
None.

UNANTICIPATED EVENTS/COMPLICATIONS:
None.

APPROACH:
Upper left chest.

DESCRIPTION OF PROCEDURE:
The patient was brought to the operating suite, where the upper left
chest area was prepped and draped in usual sterile fashion. Adequate
general anesthesia was obtained by the Anesthesia Department. Venography
was performed, which does not completely ensure patency of the left
subclavian vein. In fact, I think there is a large collateral there.
We were successful in accessing this large collateral and then after
dilating up this area and manipulating it past with various wires gaining
access to the right heart, eventually a coronary sinus guide was introduced,
and with great difficulty an inferior lateral wall vein was chosen and
the St. Jude biventricular LV lead placed out. The left lateral wall
thresholds measured and found to be acceptable. Leads connected to
the new St. Jude biventricular ICD. The deep tissue checked for dryness
and closed with 3-0 Vicryl. Skin was closed with 4-0 Monocryl in a
running,
subcuticular fashion. Pressure was applied. The patient sent to recovery
room in stable condition.

 

[CodeProAl]

upgrade of ICD to biventricular system

Look at the two codes below...

33225 for insertion of coronary venous lead and
33263 OR 33264 for replacement of the generator.

You should choose between the 33263 and 33264 based on the # of final existing lead(s). For example, if the physician replaces the generator for dual lead system (right atrium and right ventricle) with a biventricular generator and adds a coronary venous lead, you should select 33264 for the generator replacement since the patient would now have leads in 3 chambers.

Revision of the skin pocket at the time of the upgrade is not coded separately unless it involves I&D and drainage of a hematoma or complex wound infection, in which case a code from the Integumentary part of the CPT book could be added. Also, CPT guidelines state that pocket relocation at the time of generator replacement can be reported separately with code 33223.

I hope this helps you!!

 

[calorom2]

Thank you!!