# Upgrade pacer report



## em2177 (Apr 5, 2012)

NEED HELP CODING THIS REPORT. IS THIS CORRECT: 33214?  THANK YOU!!!

REOPERATIVE DIAGNOSES:
1. History of paroxysmal atrial fibrillation.
2. Sinus rhythm now.
3. History of VVI pacemaker.
4. Fatigue and pacemaker syndrome.

POSTOPERATIVE DIAGNOSES:
1. Successful implantation of right atrial leads, St. Jude
   Medical lead.
2. Successful implantation of new pulse generator dual-chamber,
   St. Jude Medical.
3. Exacerbation of asthma due to vancomycin.

METHOD:
Risks and benefits were explained to the patient, including the risk
of death, MI, stroke, bleeding, and infection. The patient was taken
to the outpatient Cardiology suite and risks and benefits were
explained to the patient. Patient agreed to dual-chamber pacemaker.
Patient has pacemaker syndrome due to pacing the ventricle, currently
in sinus rhythm.

Patient was taken to the cath lab in a fasting state, prepped in the
usual sterile fashion. Xylocaine 1% was applied to the left chest
wall, this causing local sedation. A combination of blunt and sharp
dissection created and opened up the pacemaker pocket. During the
procedure, patient had some shortness of breath and some wheezing was
noted that this was probably due to vancomycin and histamine release.
Patient was given IV Solu-Medrol and Benadryl during the procedure.
Thereafter, we did a venogram of the left subclavian vein to evaluate
the left subclavian vein. Using the 19-gauge needle, we were able to
access the left subclavian vein successfully with one stick. We
placed an 8-French sheath into left subclavian vein, a combination of
curved and straight stylets were used to quickly place the RA lead in
the right atrial appendage. Appropriate thresholds and impedance
were found. High output voltage did not stimulate the diaphragm.
Thereafter, I called the respiratory therapy to give some breathing
treatments to patient, she did have some more wheezing. Respiratory
therapy can give two breathing therapies with albuterol. Patient
subsequently felt better, did not have drop in O2 saturation,
Anesthesia was present and they tried monitoring the patient whole
time. Thereafter, we explanted the old device and removed the
capsule and we put a new lead into the new St. Jude Medical pulse
generator and we placed the right ventricle lead also into new St.
Jude Medical pulse generator. We copiously flushed the pocket with
antibiotic solution and then we put the device back into the pocket
and sutured down to the chest wall. We put ______ inside the pocket
and closed the pocket with running 2-0 and 4-0 Monocryl and placed
Dermabond superficially. Patient did have an asthma exacerbation, it
was probably due to vancomycin and we tried to give ciprofloxacin
during the procedure. Complications, asthma exacerbation. Estimated
blood loss less than 10 cc.

PACEMAKER DATA:
Patient had St. Jude Medical pulse generator, patient
explanted St. Jude Medical pulse generator.
Patient's chronic RV lead is a St. Jude Medical. Patient's new RA lead is a St. Jude Medical.

LEAD MEASUREMENTS:
P waves are 6.2 millivolts, impedance of 400 volts, threshold of 0.9
volts at 1.5 msec. Impedance in the ventricle 415 ohms, threshold of
0.7 volts at 0.4 milliseconds. The patient's pacing parameter set at
DDR ______, max rate of 120. Patient had stat chest x-ray and
pulmonary consultation will be made for her asthma exacerbation.


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## theresa.dix@tennova.com (Apr 6, 2012)

em2177 said:


> NEED HELP CODING THIS REPORT. IS THIS CORRECT: 33214?  THANK YOU!!!
> 
> REOPERATIVE DIAGNOSES:
> 1. History of paroxysmal atrial fibrillation.
> ...



these reports are confusing at times, but it looks to me like you are right. I found this chart you might find helpful. Just copy and paste 

https://www.unitedhealthcareonline....ogy_Notification_Table_CPT_Code_Crosswalk.pdf


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## em2177 (Apr 6, 2012)

Thank you!!! I appreciate your help. The chart is very useful.


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