# Pacemaker - I'm just not sure how to code this



## jewlz0879 (Dec 28, 2011)

I'm just not sure how to code this. Any help is greatly appreciated. 

PROCEDURE
After obtaining informed consent, the patient was pre-medicated per the CRNA of the
Anesthesia department after being transported to the Operating Room. The left and right
pectoral areas were prepped and draped in sterile fashion. Conscious sedation was
administered as needed throughout the procedure. 1% Xylocaine was used to create an area of local anesthesia 2 cm below the left clavicle. An incision was made from the midclavicular line to the deltopectoral groove. Blunt and sharp dissection was then used to open the pacemaker pocket below the incision line. Electrosurgical cautery was used to maintain hemostasis. The pacemaker, 1Guidant model #1276 serial #8675309, was explanted and disconnected from the chronic leads: Guidant atrial lead, model #4015, serial #PED, and Guidant ventricular lead, model #4034, serial #11359. A pacemaker system analyzer was used to evaluate pacing and sensing thresholds of the chronicleads, both implanted on May 7, 2001. 

Ventricular pacing thresholds were 0.7 volts and 1.2 milliamps at 0.5-millisecond pulse duration. 
Pacing impedance was 720 Ohms. Intracardiac R wave amplitude was 10.5 millivolts.
Atrial pacing thresholds were 1.5 volts and 2.8 milliamps at 0.5 millisecond pulse duration.
Pacing impedance as 540 Ohms. Intracardiac P wave amplitude was 1.50 millivolts. 

The chronic leads were attached to a Guidant pacemaker, model #1296, 388410 serial, which was programmed to the following parameters:
Mode: DDDR - (accelerometer)
Programmed Rate: 70 ppm
Rate Hysteresis: --- ppm
Upper Tracing Rate: 130 ppm
Upper Rate Response: Wenckebach
A-V Delay: 150-300 ms
ATRIAL SETTINGS VENTRICULAR SETTINGS
Output Amplitude: 3.0 Volts 2.5 Volts
Pulse Duration: 0.5 ms 0.5 ms
Sensitivity: 0.5 mV 2.5 mV
Refractory Period: 300 ms 250 ms

The pacemaker was placed into the pocket. The pacemaker was noted to be pacing and sensing in normal function. The pocket was copiously irrigated with Ancef solution. The subcutaneous tissue was closed using 2-0 Vicryl and the skin was closed using 4-0Monocryl in a subcuticular stitch. The wound was covered with steri-strips and 4x4's. The patient tolerated the procedure well with an estimated blood loss of 10 cc. ECG will be
obtained. Antibiotic and pain medications were ordered for the patient.


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## Jim Pawloski (Dec 29, 2011)

jewlz0879 said:


> I'm just not sure how to code this. Any help is greatly appreciated.
> 
> PROCEDURE
> After obtaining informed consent, the patient was pre-medicated per the CRNA of the
> ...



I would use 33233 for removal and 33213 for change of generator.  In a couple days you will use 33228 which is removal and replacement of dual chamber pacemaker system.
HTH,
Jim Pawloski, CIRCC


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