# pocket revision need to be coded?



## indirakumaris (Apr 29, 2012)

Hi
  kindly do conform the codes that has been coded for this report below

33208,33233,33222-59


PROCEDURE PERFORMED:
1. Dual Chamber Permanent Pacemaker
2. Single-chamber permanent pacemaker explant
3.  Pocket revision

PROCEDURE NOTE:
The patient was brought to the interventional laboratory in the postabsorptive state. Informed consent was documented in the chart. The patient's right chest was sterilely prepped and draped in the usual fashion. Bilateral venograms were performed showing complete occlusion of the left subclavian venous system communicating with the superior vena cava using collateral vessels. A right-sided subclavian vein venogram documented patency. Incision was made over the deltopectoral groove. The subclavian vein was cannulated using a micropuncture set. An 11 blade was used to cannulate the cephalic vein using a 4 French sheath. A Glidewire was then placed through the sheath in the subclavian vein and parked in the inferior vena cava. A 9 French sheath was placed over the glide wire into the subclavian vein. Under fluoroscopic guidance an ventricular lead was then placed through the sheath in the right ventricle and manipulated with stylette into the apical septum. The active fixation mechanism was then deployed in the lead tested. The sheath was then peeled away and a second 7 French sheath was placed over the wire in the subclavian vein. Atrial lead was placed in the area of the right atrium  and using preformed stylette was the lead was manipulated in the atrial appendage. The active fixation mechanism was then deployed and the stylette removed. Both leads were tested with high-output pacing and did not capture diaphragm. The leads were secured to the pectoralis muscle using 0 silk sutures. A pocket was formed and washed with antibiotic solution. The leads were connected to the pacemaker generator and the leads with generator then delivered to the pocket. The generator was secured and the incision closed with successive Vicryl sutures. Attention was then directed at the left chest where the existing device was implanted. A small incision was made over the device and using blunt dissection the device was discovered and explanted from the existing atrial lead. Extensive debridement of pocket was performed. The incision was closed using successive Vicryl sutures. The incision was bandaged and the patient transferred back to the telemetry floor in stable condition.

Thanks 
Indira


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## twizzle (Apr 30, 2012)

*Pocket revision*



indirakumaris said:


> Hi
> kindly do conform the codes that has been coded for this report below
> 
> 33208,33233,33222-59
> ...



I wouldn't bill the revision. He is getting paid for the insertion of a system which includes creating the pocket, and all he is doing with the left-sided pocket is really just closing it. Insurance will not pay for this as he's not 'revising' the pocket and , in any case, what diagnosis would you use?. You could perhaps bill for debridement instead which would need a 59 modifier but you still need a payable diagnosis which I don't see.


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