# End of Life AICD dual chamber



## em2177 (Mar 1, 2012)

How would I code the reprogramming of the pacemaker???

33249
93641-26/51

Thanks!

PREPROCEDURE DIAGNOSIS:
End of life automatic implanted cardioverter defibrillator dual
chamber.

POSTOPERATIVE DIAGNOSES:
1. Successful explantation of old automatic implanted
   cardioverter defibrillator, St. Jude Medical. Successful
   implantation used St. Jude Medical.
2. Successful pocket repositioning and capsule removal.
3. Successful reprogramming of new automatic implantable
   cardioverter-defibrillator.
4. Successful reprogramming of old pacemaker.

INDICATIONS:
The patient is a very pleasant 84-year-old lady with end of life
AICD.

DESCRIPTION OF PROCEDURE:
Risks and benefits explained to the patient and family. The risks
include death, MI, stroke, bleeding, infection, which is less than
1%. Patient was taken to the EP lab fasting state, prepped in
sterile fashion. The patient has no underlying rhythm. She had old
pacemaker on the left side that was left in place for this purpose
only. Therefore, the pacemaker was turned on temporary pacing
backup, as the old defibrillator has been removed. The old pacemaker
was a St. Jude medical pacemaker that was turned off to VVI60, during
removal of the AICD, since patient has no underlying rhythm.
Therefore, we turned off the defibrillator, turned on the old
pacemaker. We cleaned the chest wall with appropriate Betadine. We
gave appropriate anesthetic sedation with subcu lidocaine. We did
not give any Versed or general anesthesia to the patient. This was
all done under local. We opened up the previous AICD pocket on the
right side. We created and repositioned a new pocket to accommodate
the new device. Removed the previous capsule. We took tedious care
to cautery to get rid of any bleeding complications. Afterwards, we
flushed the pocket copiously with antibiotic solution, placed FloSeal
and Ancef powder into the pocket. Placed the device into pocket,
closed the pocket with running 2-0 and 4-0 Monocryl, and we cleaned
the pocket with peroxide and Dermabond. Patient tolerated the
procedure uneventfully. There were no complications.

ESTIMATED BLOOD LOSS:
Less than 10 cc.

AUTOMATIC IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR DATA:
Patient has a new St. Jude Medical AICD. Patient has chronic
RV lead, St. Jude Medical. Patient
has chronic RA lead, St. Jude Medical.
Explanted generator St. Jude Medical.

LEAD MEASUREMENTS:
R-wave was not measured. Patient has no underlying. Threshold 0.3 V
at 0.5 msec. P waves 3.1 mV, impedance 310 ohms, threshold 0.5 at
0.5 msec. Shock impedance of 44 ohms. Pacing parameters set at DDR
70, max sensor 1 at 10. The old pacemaker on the left side was
turned off back to OVO.

CONCLUSION:
Successful implantation of new St. Jude Medical pulse generator with
pocket repositioning with programming of old pacemaker on the left
side with reprogrammed new AICD in the right side. Patient will be
placed on antibiotics, will be discharged home with followup.


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## Jim Pawloski (Mar 2, 2012)

em2177 said:


> How would I code the reprogramming of the pacemaker???
> 
> 33249
> 93641-26/51
> ...



New codes!
33263 - Removal and reinsertion of ICD Generator - Dual Leads
93641 - No documentation of placing the patient into an arrythmia, and ICD making the conversion.  So I don't bevieve 93641 can be coded.
HTH,
Jim Pawloski, CIRCC


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## em2177 (Mar 2, 2012)

Thank You!


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