# Pacemaker - Hello, I coded this procedure as 33227



## Goyard71 (Aug 30, 2013)

Hello, I coded this procedure as 33227 and 33210. I am confused whether to bill it as 33228 or 33227.

Thank you very much.

Procedure performed: Pacemaker explantation and implantation
Procedure Diagnosis:
1.End of life, St. Jude Medical pulse generator
2.Complete heart block

Post procedure diagnosis:
1.Succesful explantation of St. Jude medical pulse generator
2.Succesful implantation of new Guidant pacemaker pulse generator.
3.Temporary wire placement under fluoroscopy
4.Removal of capsule and pocket.

Indications: The patient is a very pleasant lady with history of complete heart block whose pacemaker is approaching end of life.
Procedure in Detail: Methods,risks, and benefits were explained to the patient, including risk of death,MI, stroke,bleeding and infection. The patient was taken to the EP lab in a fasting state. She was prepped in the usual fashion on the right groin using appropriate antiseptics. In sterile fashion, we placed a 5-French sheath in the right femoral vein. Using a balloon EP-pacing catheter, we placed the RV lead in the Rv apex,we put a temporary wire in during the procedure.
Once that was placed we went ahead and prepped the chest wall in sterile fashion.With a combination of blunt and sharp dissection we created and opened up the pacemaker pocket. The pacemaker pocket was excised and cautery was used for meticulous hemostasis.  Afterwards, we flused the pocket with antibiotic solution and placed Ancef powder within the pocket. We revised the pocket to accommodate a new, larger pacemaker.
Once we had explanted the St. Jude pulse generator, the Guidant pacemaker was implanted. We placed surgical within the pocket and closed the pocket with running 2-0 and 4-0 Monocryl. Dermabond was placed superficially. The patient tolerated the procedure uneventfully, there were no complications.
Estimated blood loss: less than 10 ml
Complications: None
Pacemaker data:
New Pacemaker
1.Pulse generator: Guidant/Boston Scientific Altrua 60 DVDR, model S606, serial#202482
2.RA lead: Pacesetter model 1488, serial# NA91296
3.Rv lead: Pacesetter model 1488
Explanted Pacemaker: St. Jude Medical model 5810,serial #1839897
Lead measurements:
1.P waves of 2.7 mV threshold 1V at 0.5 msec,impedance of 420 ohms.
2.There is no R-waves intrinsic rhythm. Threshold 1.0 V at 0.5 msec,impedance of 480 ohms. Current 2.1 mA
3. Pacing parameters set at DDD 60, max rate of 130

Plan:
The patient will be observed for 4 hours and will be placed on oral antibiotics.


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## dloranger (Aug 30, 2013)

I believe a dual Pacer generator change is coded as 33228.


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## AB87 (Aug 30, 2013)

After Review 33228 Will be the most extensive procedure


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## Goyard71 (Aug 30, 2013)

*pacemaker*



Goyard71 said:


> Hello, I coded this procedure as 33227 and 33210. I am confused whether to bill it as 33228 or 33227.
> 
> Thank you very much.
> 
> ...



Thank you very much!!!


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