# AICD Lead Revision/Replacement Report



## em2177 (May 17, 2012)

Need help coding this report. Would this be correct: 33249,33244,33216?
Thank You.

PREPROCEDURE DIAGNOSIS:
1. Syncope.
2. Nonsustained ventricular tachycardia.
3. Cardiomyopathy of 35%.
4. History of dual-chamber AICD placement.

POSTPROCEDURE DIAGNOSIS:
1. Successful explantation of dual-chamber ICD from the right side with
placement of the ICD on the left side of the chest.
2. Successful implantation of new RV lead on the right side of the chest.
3. Successful implantation of pacemaker pulse generator on the left side.
4. Venogram of the left and right subclavian veins.
5. Removal of AICD lead on the left side.
6. Pocket revision.

INDICATIONS: The patient is a very pleasant gentleman with a history of
cardiomyopathy of 35%, complete heart block status post upgrade of a pacemaker
to dual-chamber AICD with elevation of RV thresholds due to position resulting
in presyncope. The patient is here for RV lead revision.
METHOD: The risks and benefits were explained to the patient, including the
risks of death, Ml, stroke, bleeding, and infection. The patient was taken to
the EP lab in a fasting state and prepped in the usual sterile fashion.
Xylocaine 1% was applied to the left chest wall.
We opened up the previous AICD pocket. I tried to move the AICD RV lead into a
better position that was more stable. Unfortunately, the lead was too short to
place it in a stable position because of the patient's height. The patient is
6 feet 6 inches tall. Therefore, it was felt that a new lead would be better
since he is pacemaker dependent.
As I removed the lead, we did a venogram. It was noted that because he had old
pacemaker leads the vein was occluded. Since the patient has complete heart
block, we used his old pacemaker RV lead to put a pacemaker on the left side as
we went to the right side to place the new AICD pulse generator and lead.
We therefore flushed the pocket with antibiotic solution and placed a Zephyr, serial, pacemaker into the pocket. We sutured it down to
the chest wall, placed Ancef powder into the pocket, and closed the pocket with
running 2-0 and 4-0 Monocryl. We placed Dermabond superficially.
Thereafter, we prepped the right side in the usual sterile fashion. We placed
1% Xylocaine onto the chest wall. Then we did a venogram of the right
subclavian vein. We were able to easily access it. We placed an 8-French
sheath into the right subclavian vein. A combination of curved and straight
stylets were used with a new Durata RV lead, 65 cm. We placed it
in the RV apex. We found appropriate thresholds and impedance. We sutured
that lead to the chest wall.
We placed the AICD that was on the right side to the left side.
We placed it into the pocket, and we sutured it down to the chest wall. We
flushed the pocket with antibiotic solution, placed Ancef powder and FloSeal
into the pocket, and closed the pocket with running 2-0 and 4-0 Monocryl. We
placed Dermabond superficially.
This was a single lead system since the patient is in chronic atrial
fibrillation. We did not do and DFT since the patient is in atrial
fibrillation without being anticoagulated appropriately for 1 month. We put
the device on maximal settings.
The patient tolerated the procedure uneventfully. There were no complications.


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## Robbin109 (May 20, 2012)

I would go with:

33249 Insert or replace ICD gen with lead, single or dual
33241  Remove ICD gen only
33244 Remove lead
33212 Pacer gen implant ( if for a single lead, he doesn't say anything about the RA         
           lead???)

Second opinion?


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