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Thread: Failed upgrade to Bi-V from AICD

  1. #1
    Join Date
    Apr 2007
    Bentonville, AR

    Default Failed upgrade to Bi-V from AICD

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    Bentonville, AR


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


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