# need help 33208 or 33228?



## bhargavi (Aug 17, 2017)

Procedures 

Implant PPM dual w/ new rv lead insert
Rv Lead Revision
Pre-procedure Diagnosis 

Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter [T82.111A]
	Link to Procedure Log 

Procedure Log

Indications 
Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter [T82.111A (ICD-10-CM)]
Bradycardia [R00.1 (ICD-10-CM)]
Complication associated with cardiac pacemaker lead, initial encounter [T82.9XXA 
Cardiac Pacemaker DDDR Pulse Generator Replacement and new RV Lead Operative Report
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Procedure(s): DDDR Permanent Pacemaker Pulse Generator Replacement
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Indications: 
PPM ERI
Intermittent CHB
RV lead malfunction, high pacing thresholds 5V/1.0 ms
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Hardware Implanted:  ## Not MRI COMPATIBLE ##
Boston Scientific PPM PG ACOLADE DR, MN # L301, SN # 750183
Boston Scientific active fixation right ventricular lead MN # 7741-52, SN # 781063
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Hardware Explanted: 
Boston Scientific MN S603, SN 964970
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Hardware Abandoned:
Old RV pacing lead capped and tied, high pacing threholds. MN 4163 Guidant, SN 29071227
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Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was marked and timeout done.
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The antibiotic was completely infused. The patient was prepped and draped in the usual sterile fashion and the left upper chest anesthetized with 10 cc of 50/50 mixture of 0.25% marcaine and 2% lidocaine. An incision was made in the deltopectoral groove and electrocautery used to perform dissection down to the pacemaker pocket where the pocket was incised, the device delivered. A single left subclavian vein puncture placed a guidewire into the superior vena cava. Tear-away sheath introduced the lead into the superior vena cava where fluoroscopic guidance assisted placement of the active fixation right ventricular lead into the RV apex and then lifted into the distal RV septum where the lead was actively fixated. The lead was anchored to the pectoralis fascial using 0 Ethibond. Pacing and sensing thresholds were obtained. Pacing and sensing parameters were tested. The old A lead was secured to the new device as well as the new RV lead. and the device placed in the pocket after expanding the pocket, irrigation with an antibiotic solution, and hemostasis. 
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The Incision was closed in 3 layers, the lower two with running 2-0 Vicryl and the cutaneous with 4-0 Vicryl. Steri-Strips and a dry sterile dressing were placed over the wound and the patient was transferred to the PACU in stable condition for recovery from anesthesia. The patient's underlying rhythm was NSR with 1:1 AV conduction, LBBB, with intermittent CHB.
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Measured Data: P wave 4.4 mV, 441 ohms, thr 1.3 V at 0.4 ms
R wave 12.8 mV, 899 ohms, thr 1.1 V at 0.4 ms
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Final Parameters: DDDR 60-120

so the physician did dual pacemaker gen change and add new rv lead with old ra lead and he wants to bill his charges as gen change and new lead insertion which you can't bill according to cci edits whenever there is new lead its new implant which in this case will be 33208. am I correct?
thanks in advance
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## Jim Pawloski (Aug 21, 2017)

bhargavi said:


> Procedures
> 
> Implant PPM dual w/ new rv lead insert
> Rv Lead Revision
> ...



33233 and 33207 should be charged.
HTH,
Jim Pawloski, CIRCC


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## bhargavi (Aug 22, 2017)

*so even though its dual ppm I bill 33207? not 33208?*

so even though its dual ppm I bill 33207? not 33208?


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## Jim Pawloski (Aug 23, 2017)

bhargavi said:


> so even though its dual ppm I bill 33207? not 33208?



because it's the old RA lead, so you actually inserted the RV lead and the generator. That's how you code it.
HTH,
Jim


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