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Failed upgrade to Bi-V from AICD

  1. #1
    Default Failed upgrade to Bi-V from AICD
    Medical Coding Books
    I am struggling with this procedure. It was a failed procedure but modifier 53 and 52 are not allowed to be billed with the 33224. I have copied the procedure note below...any advice would be appreciatated.

    Thank you

    Kim Floyd, CPC

    The patient has congestive heart failure, class III with
    dilated cardiomyopathy of less than 25% with QRS above 130. Risks,
    benefits, alternatives, gross possible complications, need for team
    approach were discussed with the patient and her daughters, and
    informed consent was obtained.

    A 6-cm incision was made into the left pectoral area with blunt and
    sharp dissection. I freed the AICD leads as well as the
    defibrillator. I accessed the left axillary vein and advanced
    initially a CPS 35 cm then used a CPS wide, then CPS straight through
    the procedure, and we tried to advance a QuickFlex 1258T/86 cm micro
    into the coronary sinus. the angiography of the coronary sinus in
    multiple views showed only 1 very large suitable lateral vein that
    was very tortuous. I was not able to stabilize the lead in a
    suitable location. After more than 60 minutes of fluoro time, I
    decided to stop. The defibrillator was placed back into the pocket,
    and the incision closed with 2-0 Vicryl x3 layers and skin staples.

    PLAN We will consult CT surgery for possible epicardial lead and
    upgrade to Bi-V.

  2. #2
    Figured it out and in case anyone wants to this example the venogram would be charged since the 52 and 53 aren't allowed with 33224


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