Cardiology Coding Alert

Warning: Unless the MD describes a fluoroscopy, you should not report itTo report failed pacemaker and automatic internal cardioverter defibrillator (AICD) implantation procedures, try zooming in on the pacemaker type.See if you can underline the necessary information in the procedure note and determine the correct codes for this patient's operation.Case: The patient is a 69-year-old woman with an arrhythmic-related cardiac arrest. She has an extensive history of heart disease as well as prior cardiovascular surgery including pacemaker placement in 2005. A cath, which the physician performed earlier, revealed normal coronaries. The cardiologist then tested the existing pacemaker and found several episodes of sustained ventricular tachycardia. Based on these findings, the cardiologist decides to place an implantable cardioverter defibrillator (ICD).Pick Apart This Procedure NoteBecause the patient had very little subcutaneous tissue or muscle tissue in the pectoral regions, the cardiologist elected to place the system in the abdomen.
Using Xylocaine 1% local anesthesia, the physician made a left delta pectoral incision and a cephalic vein cutdown. Then he introduced the Medtronic ICD lead Model 6945 (100 cm). The physician secured the lead to the underlying subcutaneous tissue and a loop made in the delta pectoral region. Then he anchored another sleeve.He tunneled the lead down to the abdomen where the physician made an incision using blunt dissection. He fashioned a pocket and irrigated it with antibiotic solution. He connected a Medtronic Gem 7227CX ICD and then placed in the abdominal pocket and anchored to the underlying subcutaneous tissues.He closed the subcutaneous tissue and subcuticular tissue. Prior to closure of the skin sutures, he performed a V-fib induction. The first episode of ventricular fibrillation failed at 8 joules, but at 14 joules was successful in converting the rhythm to sinus.The physician created a second episode of ventricular fibrillation and terminated promptly to sinus rhythm with a 14-joule shock.Then the cardiologist turned his attention to the removal of the existing pacemaker system. The lead, with its significantly reduced impedance, was a problem. In addition, the atrial lead was nonfunctional, given the patient's chronic atrial fibrillation. The physician made an incision over the area of the existing generator and carefully explanted it. He capped the leads, then secured and placed them back in the pocket. He irrigated the existing pocket using antibiotic solution.There were no complications, and the patient left the cardiovascular lab in satisfactory condition.Step 1: Watch Out for This Major PitfallBefore you delve into the coding process, you should make certain you know which device the cardiologist describes in the note.Why: "Many times I see physicians using the terms 'pacer' and 'AICD' interchangeably. It really does make a difference when you are coding them," says Cheryl Klarkowski, RHIT, CPC, coding specialist for Baycare [...]