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Help with coding pacer report

  1. #1
    Location
    Jacksonville Florida
    Posts
    126
    Default Help with coding pacer report
    Medical Coding Books
    Hi everyone. Can someone help with coding this report. I don't see these cases too often. Thanks in advanced!!

    Here's how I coded it:
    33233 DX:996.01
    33213 996.01
    71090-26 996.01
    33210-59 427.81
    71090-26,59 427.81

    NAME OF TEST:
    1. DDDR permanent pacemaker battery change out.
    2. Insertion of a transvenous temporary ventricular pacemaker via the
    right femoral vein.

    HISTORY
    The patient is a very pleasant, 80-year-old male who has a history of sick
    sinus syndrome and complete heart block. He had a Medtronic permanent
    pacemaker implanted by me back in 2002. He has been followed in our office
    regularly. He was seen in the office and noted to be at elective
    replacement. He was brought in to have a DDDR permanent pacemaker battery
    change out procedure performed. The patient was noted to be pacemaker
    dependent in the ventricular chamber. Arrangements were made for the patient
    to have a temporary pacemaker placed as well.

    PROCEDURE
    The patient was brought to the cardiac catheterization laboratory in very
    stable condition. Both groins were prepped and draped in the usual sterile
    fashion. Both subclavian areas were prepped and draped as well. We first
    turned our attention to the right femoral area. Using 1% Xylocaine, the
    right femoral area was anesthetized. The patient was given some intravenous
    sedation. Please see the accompanying nursing data sheet for full details
    regarding his sedation. We then successfully cannulated the right femoral
    vein and a 6 French sheath was placed without difficulty. A 5 French
    temporary ventricular pacemaker catheter was then placed without difficulty
    in the right ventricle. Excellent thresholds were obtained. We then placed
    the temporary pacemaker at a backup rate of 50 beats per minute on full
    demand pacing.

    We then turned our attention to the left subclavian area. I exchanged out
    for a new sterile gown and new sterile gloves. Using 1% Xylocaine, we
    anesthetized the left subclavian area in the subcutaneous tissue over the old
    permanent pacemaker pulse generator. Using a scalpel, a 4 cm horizontal
    incision was then made into the subclavian area over the old permanent
    pacemaker pulse generator. The pacemaker capsule was then entered.
    Utilizing a curved hemostat, I was able to dissect out the old permanent
    pacemaker pulse generator from the pacemaker capsule. The old permanent
    pacemaker pulse generator was then brought out to the surface of the skin.
    We then disconnected both leads from the old permanent pacemaker pulse
    generator. We checked thresholds on both leads. From the atrial lead they
    were as follows:
    1. Voltage 0.4 volts.
    2. P wave 4.1 millivolts.
    3. Resistance 513 ohms.

    These thresholds in the atrial lead were thought to be quite good, especially
    for chronic thresholds. I then checked the thresholds on the ventricular
    lead. They were as follows:
    1. Voltage 0.7 volts.
    2. R wave 8.5 millivolts.
    3. Resistance 972 ohms.

    These thresholds were also thought to be quite good with regards to the
    ventricular lead as well. We then irrigated out the pacemaker pocket very
    vigorously with antibiotic solution. I took a piece of 4 x 4 gauze and
    saturated it with antibiotic solution. I then proceeded to wipe down both
    pacemaker leads very carefully as well as then new permanent pacemaker pulse
    generator. We connected the new permanent pacemaker pulse generator to both
    leads. I documented adequate capture in both leads. We then used the
    sterile programming head in order to program the new permanent pacemaker
    pulse generator. During this time, the new permanent pacemaker pulse
    generator and excess pacemaker leads were placed in the pacemaker pocket.
    The subcutaneous tissue was closed in an interrupted layer of 2-0 Vicryl
    suture. The skin was then closed with staples. During this time, the
    temporary pacemaker leads was removed under fluoroscopy without difficulty.

    The explanted pacemaker was a Medtronic, model #KDR901. The new permanent
    pacemaker pulse generator is a Medtronic Versa, model #VEDR01, serial
    #NWH223704H. The pacemaker is set in the DDD mode at a lower rate of 60 and
    upper rate of 120 beats per minute. Both chambers were set at nominal
    settings. Both leads were set in a bipolar configuration.

    CONCLUSION
    1. Successful DDDR permanent pacemaker battery change out.
    2. Successful insertion of a transvenous temporary ventricular pacemaker
    via the right femoral vein.
    Jammie Barsamian, CPC, CCC, CEMC, CCS-P, CPMA

  2. Default
    Hello,

    You are on the right track..however, I'm not sure about billing 71090-26 twice; if it is allowed or payable, add modifier 76. see below. I dont know of any specific coding rules for the diagnosis as far as needing add'l codes. In this case you could add 427.81 & 426.0 with V53.31. Some payers will not pay on claims using "V" codes.

    33233 DX:V53.31
    33213 V53.31
    71090-26 V53.31
    33210-59 427.81, 426.0
    71090-26,76-59 427.81, 426.0

    I use V53.31 for "end of life" status of the pacemaker generator. In the index under change(s) of - battery it shows this code. 996.01 is for mechanical complication, breakage or malfunction of the lead.

    996.01 -complications peculiar to certain specified procedures; mechanical complication of cardiac device, implant, and graft; due to cardiac pacemaker (electrode)

    I hope this makes sense.

  3. #3
    Location
    Jacksonville Florida
    Posts
    126
    Default
    Quote Originally Posted by deeva456 View Post
    Hello,

    You are on the right track..however, I'm not sure about billing 71090-26 twice; if it is allowed or payable, add modifier 76. see below. I dont know of any specific coding rules for the diagnosis as far as needing add'l codes. In this case you could add 427.81 & 426.0 with V53.31. Some payers will not pay on claims using "V" codes.

    33233 DX:V53.31
    33213 V53.31
    71090-26 V53.31
    33210-59 427.81, 426.0
    71090-26,76-59 427.81, 426.0

    I use V53.31 for "end of life" status of the pacemaker generator. In the index under change(s) of - battery it shows this code. 996.01 is for mechanical complication, breakage or malfunction of the lead.

    996.01 -complications peculiar to certain specified procedures; mechanical complication of cardiac device, implant, and graft; due to cardiac pacemaker (electrode)

    I hope this makes sense.
    Yes it does. Thanks a lot for your help
    Jammie Barsamian, CPC, CCC, CEMC, CCS-P, CPMA

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