# Pacer Lead Revision



## lcouto (Mar 14, 2013)

My doctor did a dual pacer insertion on 2/25 and then the patient had to go back in 3/7 for a Ventricular lead revision for Pacemaker lead malfunction, not sure how to code the lead revision....help please...

Thanks,
Lisa
Here is a copy of the report

Pre-procedure Diagnoses 
  1. Pacemaker lead malfunction   
  Post-procedure Diagnoses 
  1. Pacemaker lead malfunction  
  BRIEF OPERATIVE NOTE


Date of Surgery:
3/7/2013




Pre-operative Diagnosis:  
Pacemaker lead malfunction


Post-operative Diagnosis:  
Same as above


Procedure Performed :
Ventricular lead revision




Anesthesia:   
Moderate Conscious Sedation


Total IV Fluids & Blood loss;
Minimal blood loss



Implants and Procedure Description:  
After informed consent was obtained, the patient was transported in a nonsedated condition to the cardiac catheterization suite. The patient was given moderate conscious sedation. The patient was prepped and draped in a sterile fashion and a "timeout" was taken.  


ACCESS and POCKET FORMATION:
Lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the left pectoralis muscle. Sharp incision was made in the skin through the previous pacemaker scar line. Utilizing a combination of sharp and blunt dissection, the pocket was opened and the pacemaker explanted.

Utilizing curved and straight stylettes, the ventricular lead was repositioned and secured in the right ventricular septal wall apex. It was tested and found to have R waves of 8.7 mV, impedance 853 ohms, threshold was 0.4 volts, current 0.5 milliamps. Adequate slack was placed in the lead under fluoroscopic guidance. The lead was tested with output of 10 V and did not stimulate the diaphragm. The ventricular lead was then secured to the pectoralis muscle with non-resorbable suture. I then reattached the pulse generator. The leads and pulse generator were incorporated in the pocket. The pocket was copiously irrigated. The subcutaneous fascia was closed with interrupted Vicryl suture. The skin layer was closed with a subcuticular Vicryl stitch. Final fluoroscopy demonstrated adequate slack in the leads. The wound was dressed in a sterile fashion.


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## Cyndi113 (Mar 15, 2013)

Without seeing the op report, it's difficult to say for sure. Here are two suggestions: look at 33218 and 33224. Make sure to use the appropriate complication code as well as -78.

good luck,


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## HEMINGWAYT (Mar 15, 2013)

How about a 33215 for Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator electrode (right atrial or right ventricular) with a 78  modifier for Unplanned return to the OR for a related procedure during the post operative period.


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## theresa.dix@tennova.com (Mar 18, 2013)

HEMINGWAYT said:


> How about a 33215 for Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator electrode (right atrial or right ventricular) with a 78  modifier for Unplanned return to the OR for a related procedure during the post operative period.



I agree with above 33215 is your code.


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## lcouto (Mar 18, 2013)

Thank you very much!!!!


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