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Thread: Pacemaker - I'm just not sure how to code this

  1. #1
    Join Date
    Apr 2007
    Location
    Richardson, TX
    Posts
    817

    Default Pacemaker - I'm just not sure how to code this

    Promo: Code Books
    I'm just not sure how to code this. Any help is greatly appreciated.

    PROCEDURE
    After obtaining informed consent, the patient was pre-medicated per the CRNA of the
    Anesthesia department after being transported to the Operating Room. The left and right
    pectoral areas were prepped and draped in sterile fashion. Conscious sedation was
    administered as needed throughout the procedure. 1% Xylocaine was used to create an area of local anesthesia 2 cm below the left clavicle. An incision was made from the midclavicular line to the deltopectoral groove. Blunt and sharp dissection was then used to open the pacemaker pocket below the incision line. Electrosurgical cautery was used to maintain hemostasis. The pacemaker, 1Guidant model #1276 serial #8675309, was explanted and disconnected from the chronic leads: Guidant atrial lead, model #4015, serial #PED, and Guidant ventricular lead, model #4034, serial #11359. A pacemaker system analyzer was used to evaluate pacing and sensing thresholds of the chronicleads, both implanted on May 7, 2001.

    Ventricular pacing thresholds were 0.7 volts and 1.2 milliamps at 0.5-millisecond pulse duration.
    Pacing impedance was 720 Ohms. Intracardiac R wave amplitude was 10.5 millivolts.
    Atrial pacing thresholds were 1.5 volts and 2.8 milliamps at 0.5 millisecond pulse duration.
    Pacing impedance as 540 Ohms. Intracardiac P wave amplitude was 1.50 millivolts.

    The chronic leads were attached to a Guidant pacemaker, model #1296, 388410 serial, which was programmed to the following parameters:
    Mode: DDDR - (accelerometer)
    Programmed Rate: 70 ppm
    Rate Hysteresis: --- ppm
    Upper Tracing Rate: 130 ppm
    Upper Rate Response: Wenckebach
    A-V Delay: 150-300 ms
    ATRIAL SETTINGS VENTRICULAR SETTINGS
    Output Amplitude: 3.0 Volts 2.5 Volts
    Pulse Duration: 0.5 ms 0.5 ms
    Sensitivity: 0.5 mV 2.5 mV
    Refractory Period: 300 ms 250 ms

    The pacemaker was placed into the pocket. The pacemaker was noted to be pacing and sensing in normal function. The pocket was copiously irrigated with Ancef solution. The subcutaneous tissue was closed using 2-0 Vicryl and the skin was closed using 4-0Monocryl in a subcuticular stitch. The wound was covered with steri-strips and 4x4's. The patient tolerated the procedure well with an estimated blood loss of 10 cc. ECG will be
    obtained. Antibiotic and pain medications were ordered for the patient.
    Julie Graham, BA, CPC, CCC

  2. #2
    Join Date
    Apr 2007
    Location
    Ann Arbor
    Posts
    1,027

    Default

    Quote Originally Posted by jewlz0879 View Post
    I'm just not sure how to code this. Any help is greatly appreciated.

    PROCEDURE
    After obtaining informed consent, the patient was pre-medicated per the CRNA of the
    Anesthesia department after being transported to the Operating Room. The left and right
    pectoral areas were prepped and draped in sterile fashion. Conscious sedation was
    administered as needed throughout the procedure. 1% Xylocaine was used to create an area of local anesthesia 2 cm below the left clavicle. An incision was made from the midclavicular line to the deltopectoral groove. Blunt and sharp dissection was then used to open the pacemaker pocket below the incision line. Electrosurgical cautery was used to maintain hemostasis. The pacemaker, 1Guidant model #1276 serial #8675309, was explanted and disconnected from the chronic leads: Guidant atrial lead, model #4015, serial #PED, and Guidant ventricular lead, model #4034, serial #11359. A pacemaker system analyzer was used to evaluate pacing and sensing thresholds of the chronicleads, both implanted on May 7, 2001.

    Ventricular pacing thresholds were 0.7 volts and 1.2 milliamps at 0.5-millisecond pulse duration.
    Pacing impedance was 720 Ohms. Intracardiac R wave amplitude was 10.5 millivolts.
    Atrial pacing thresholds were 1.5 volts and 2.8 milliamps at 0.5 millisecond pulse duration.
    Pacing impedance as 540 Ohms. Intracardiac P wave amplitude was 1.50 millivolts.

    The chronic leads were attached to a Guidant pacemaker, model #1296, 388410 serial, which was programmed to the following parameters:
    Mode: DDDR - (accelerometer)
    Programmed Rate: 70 ppm
    Rate Hysteresis: --- ppm
    Upper Tracing Rate: 130 ppm
    Upper Rate Response: Wenckebach
    A-V Delay: 150-300 ms
    ATRIAL SETTINGS VENTRICULAR SETTINGS
    Output Amplitude: 3.0 Volts 2.5 Volts
    Pulse Duration: 0.5 ms 0.5 ms
    Sensitivity: 0.5 mV 2.5 mV
    Refractory Period: 300 ms 250 ms

    The pacemaker was placed into the pocket. The pacemaker was noted to be pacing and sensing in normal function. The pocket was copiously irrigated with Ancef solution. The subcutaneous tissue was closed using 2-0 Vicryl and the skin was closed using 4-0Monocryl in a subcuticular stitch. The wound was covered with steri-strips and 4x4's. The patient tolerated the procedure well with an estimated blood loss of 10 cc. ECG will be
    obtained. Antibiotic and pain medications were ordered for the patient.
    I would use 33233 for removal and 33213 for change of generator. In a couple days you will use 33228 which is removal and replacement of dual chamber pacemaker system.
    HTH,
    Jim Pawloski, CIRCC

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