AmandaBriggs
Expert
Please see report below. This is the first time we have run across this procedure in our practice and I want to be sure that we get it coded correctly.
"After the patient and site of implantation were prepped and draped in the usual sterile fashion and after adequate anesthesia was given, the skin was infiltrated with mixture of 2% lidocaine and 0.25%. The sono-site was used to cannulate the left IJ without difficulty using the modified Seldinger technique, a 7-0 French peel away sheath was placed in the IJ vein and used to a deliver lead to the right ventricular apex. The lead was attached via active fixation and demonstrated to be stable. Adequate sensing, pacing impedance and pacing threshold parameters were obtained. There was no evidence of diaphragmatic stimulation at 10 V output. The peel away sheath was removed and the lead collar was anchored to the lead at the hub of the lead, then attached to the skin using non-absorbable suture. Tug testing of the lead confirmed stability and lead slack was assessed as optimal with fluoroscopy. There was no ectopy seen after extension of the helix. The lead tip was cleaned and secured within the appropriate port on the new pulse generator. Tug testing of the lead confirmed stability and lead slack was assessed as optimal with fluoroscopy. There was no ectopy seen after extension of the helix.
The lead tip was cleaned and secured within the appropriate port on the new pulse generator. Tug testing was performed. The device and lead were placed on the neck and fastened carefully to the skin with tape redundantly.
The patient was very diaphoretic during procedure and best efforts were used to apply a sturdy and adherent dressing. The temporary R AC wire was removed under fluoro and the PICC line was visualized as in place from his R."
"After the patient and site of implantation were prepped and draped in the usual sterile fashion and after adequate anesthesia was given, the skin was infiltrated with mixture of 2% lidocaine and 0.25%. The sono-site was used to cannulate the left IJ without difficulty using the modified Seldinger technique, a 7-0 French peel away sheath was placed in the IJ vein and used to a deliver lead to the right ventricular apex. The lead was attached via active fixation and demonstrated to be stable. Adequate sensing, pacing impedance and pacing threshold parameters were obtained. There was no evidence of diaphragmatic stimulation at 10 V output. The peel away sheath was removed and the lead collar was anchored to the lead at the hub of the lead, then attached to the skin using non-absorbable suture. Tug testing of the lead confirmed stability and lead slack was assessed as optimal with fluoroscopy. There was no ectopy seen after extension of the helix. The lead tip was cleaned and secured within the appropriate port on the new pulse generator. Tug testing of the lead confirmed stability and lead slack was assessed as optimal with fluoroscopy. There was no ectopy seen after extension of the helix.
The lead tip was cleaned and secured within the appropriate port on the new pulse generator. Tug testing was performed. The device and lead were placed on the neck and fastened carefully to the skin with tape redundantly.
The patient was very diaphoretic during procedure and best efforts were used to apply a sturdy and adherent dressing. The temporary R AC wire was removed under fluoro and the PICC line was visualized as in place from his R."