# Coding Question



## LeeAnnk (Jul 31, 2007)

Our cardiology department has recently expanded and our new EP Cardiologist is performing procedures that are new to the practice. I am looking for advice in coding one in particular.

The patient is 1 month post-dual-chamber permanent pacemaker implantation. The patient's R-waves deteriorated causing inappropriate pacing.

Patient was taken back to the OR. Under local anesthesia the old incision was used to access the pocket. Device was delivered out of the wound, old pocket was removed and new pocket created. Dissection of the RV lead was done by use of hemocautery Bovie. Bovie was done down to the level of the RV collar. A Guidant curved sytlette was placed down into the lead itself. Suture was cut and the collar was pulled free. Under fluoroscopic guidance, with counterclockwise turn, the set screw was removed and with gentle traction the RV lead came free.  Using the curved stylette, the interior of the right ventricle was carefully mapped. Small R waves were found. However, distal in the right ventricle, towards the apical septum more adequate R-waves with a good injury current were found. Lead was affixed in this area and found R-waves between 8 and 22 millivolts. The lead was actively affixed with 10 clockwise screws. It was checked by pulling on the lead and lead was actively fixed at the location. The stylette was removed. Lead was sewn down to the facia. Pocket was copiously infiltrated with antibiotic solution. The RV lead was once again placed back into the generator. The generator was placed back into the pocket and once sewn down with sutures. After final check of the wound, the wound was pulled closed with a standard 2-0 Vicryll suture in the prepectoral fascia, 2-0 Vicryl in the subcutaneous tissue and 4-0 Vicryl suture in the skin. The patient received steri-strips and a tight pressure dressing.

I would appreciate assistance anyone would want to offer.


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## pokirae (Aug 14, 2007)

I'm a little confused on the POCKET being "removed".  That's a tough one.   

Okay so I will point you in a direction to look.  Look up 33215 and 33222.  See what you think.  Guidant and other EP device manufacturers can also be valuable resources for EP coding questions.  I did EP procedure coding for 3 years and they were quite helpful.  

Good luck!


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