# Infected ICD Pocket



## MrsApplegate (Sep 10, 2014)

Can someone help with this scenario?  What would be the correct CPT for removal and reinsertion of the existing generator?  I see they revised the codes for pocket revision in 2014.  Any help would be appreciated.



PROCEDURE:  ICD pocket exploration with evacuation of hematoma.

PREOPERATIVE DIANOSIS: Swollen ICD pocket.

POSTOPERATIVE DIAGNOSIS: Pocket hematoma

PROCEDURE AND FINDINGS: The procedure was discussed in detail with the patient and his family.  They understood and agreed to proceed.  The procedure was performed in the cardiac catheterization laboratory.

After routine sterile preparation and infiltration of 1% lidocaine for local anesthesia, a transverse incision was created over the ICD pocket in the left prepectoral area.  Prior to entering the pocket, a needle was used to aspirate approximately 10 mL?s of dark liquid blood, which was sent for culture.  The pocket was then opened and approximately 100 mL?s of bloody fluid was expressed.  Cultures were subsequently sent from swabs within the pocket.  There was a fair amount of spongy material that came out in small pieces with the blood.  This was sent for microscopic analysis.  The pocket was then copiously irrigated with a pressurized irrigation/evacuation device.  The pocket was noted to be somewhat thickened and with a dusky color, but there was no evidence of purulence.  The pocket was then irrigated with an antibiotic solution.  The device was placed back in the pocket with redundant leads coiled behind it.  The pocket and subcutaneous tissue was closed with Vicryl suture and the skin was closed with seven interrupted nylon sutures.  A pressure dressing was subsequently applied.  The defibrillator was subsequently tested and reprogrammed at the conclusion of the procedure.  The patient tolerated the procedure well.


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## jewlz0879 (Sep 12, 2014)

I see the generator was was taken out but only to remove the hematoma. I think your best code choice would be 10140. You could also consider CPT 10180, if this was due to infection, post ICD placement (didn't see that documented but thought I'd mention it).


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