# pocket revision



## Tmatthews (Aug 29, 2015)

Little help please...
The doctor reported revision (obviously no longer a cpt code) but i believe its a debridement code.  Input anyone?

74 year old male who presented to the clinic with left chest wound dehiscence at the site of his previous pacemaker pocket revision. He underwent recent PPM extraction following device infection. He is planned for atrial flutter ablation. He denies fevers, rigors. 

PROCEDURE 

The patient was brought to the Cardiac Electrophysiology laboratory in a post-absorptive, fasting state. Informed consent was obtained. A peripheral IV was in place. Continuous electrocardiographic, blood pressure, O2 saturation and expired CO2 monitoring was initiated. Intravenous antibiotics were administered pre-operatively. Self-adhesive cardioversion patches were positioned on the chest. Conscious sedation was effectuated according to protocol by the anesthesia service. The patient was then prepped and draped in the usual sterile fashion. A 50/50 mixture of lidocaine (1%) with epinephrine and bupivicaine (0.5%) was utilized for local anesthesia. Devitalized tissue was observed around the rim of the wound dehiscence with several sutures loosely apposing the wound edges. There was a devitalized base noted in the pocket. Extensive removal of the devitalized tissue was performed at the base of the pocket. The devitalized tissue around the rim of the wound dehiscence was also excised. Extensive bleeding was noted on the pocket and QuickClot material was applied. The pocket was then closed in four layers using 2-O vicryl, 3-O vicryl, and 4-O monocryl absorbable suture material. The skin was closed using a sub-cuticular technique. Ster-stips and a bio-occlusive dressing were applied to the skin. The patient remained hemodynamically stable, tolerated the procedure well and was transferred in stable condition. There were no immediate complications encountered during the procedure. There was minimal blood loss and no specimen were removed.


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## Tmatthews (Aug 29, 2015)

*example*

Here is another example:

PROCEDURE IN DETAIL: After informed written consent was obtained, the patient was brought to the Electrophysiology Suite where he was prepped and draped in the usual sterile fashion. Conscious sedation was initiated and maintained with intravenous Versed and fentanyl. Xylocaine was given in the left infraclavicular area around the incision line and an elliptical resection of the whole layer of skin around the lower edge of the incision where the wound is not closed entirely and the layer was lifted up to inspect for holes or drainage. I did not see any so I cut through the capsule. The pocket has no pus and the last antibiotic envelop used has dissolved. Beside the envelop granules the tissue looks clean and not infected. Swab culture was obtained on top of ICD and bottom of it inside the pocket. The pocket is now irrigated with antibiotic solutions and the leads connected to the device and inserted inside the pocket. Antibiotic powder was placed in the pocket. The pocket is now closed in three consecutive layers using 2-0 Vicryl sutures in continuous fashion. I have decided not to remove the device and the leads because the pocket once again does not appear infected grossly and the area that did not close appeared on superficial layer again. Transesophageal echocardiogram has shown no vegetation and his LVEF has significantly improved with CRT pacing. The lead positions were checked on fluoroscopy. 
The patient is now arousable and has intact neurological function.


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## twizzle (Aug 29, 2015)

Tmatthews said:


> Little help please...
> The doctor reported revision (obviously no longer a cpt code) but i believe its a debridement code.  Input anyone?
> 
> 74 year old male who presented to the clinic with left chest wound dehiscence at the site of his previous pacemaker pocket revision. He underwent recent PPM extraction following device infection. He is planned for atrial flutter ablation. He denies fevers, rigors.
> ...


I would bill debridement down to muscle/fascia. 11043 I think. It will obviously need a modifier if your provider removed the device and is still in the global.


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