Hello, I need your help. Can you please let me know if I coded this procedure right? 33249 93641 and 33225?
Thank you in advance.
Post Procedure Diagnoses:
1) Successful implantation of biventricular automatic implantable cardioverter-defibrillator in the right side.
2) Succesful implantation of right atrial lead, St. Jude Medical.
3)Succesful implantation of right ventricular lead, St. Jude medical.
4) Succesful implantation of left ventricular lead, St. Jude medical.
5)Explantation of the automatic implantable cardioverter-defibrillator single-chamber on the left side.
6)Venous occlusion, 100% in the left subclavian vein with collaterization.
7)Ischemic heart disease.
8)Heart failure, class III
Procedure Performed:
Indications: The patient is a very pleasant 79 year old gentleman with a history of ischemic cardiomyopathy, bradycardia, QRS of 130 msec. AICD has approached end of life, here for upgrade of his device to a biventricular AICD.
Procedure in detail: The risks and benefits were explained to the patient, risks of death, MI, stroke,bleeding, infections less than 1%, the patient was taken to the EP lab in a fasting state and prepped in the usual sterile fashion.
A venogram of the left chest wall was made and showed there was 100% occlusion of the left subclavian vein with collaterization. Therefore we went ahead and reprepped the right chest wall, we did a venogram and we found appropriate subclavian vein. Using a combination of blunt and sharp dissection,we opened up the AICD pocket, and using the venogram with a 19-gauge needle, We accessed the right subclavian vein. We did this twice. We placed a 9- French sheath in the right sublcavian vein. A combination of curved and straight stylets was used to place the RV lead in the RV apex. Thereafter, using the Biosense Webster EP catheter with a straight system catheter we were able to cannulate the coronary sinus. We did a venogram of the coronary sinus. We found a large posterolateral vein coming off the main coronary sinus. We found a large posterolateral vein coming off the main coronary sinus. We were able to cannulate it with the aid of a 0.032 wire. We placed a quad-lead St. Jude medical into the posterolateral vein. Appropriate thresholds and impedance were found. We were able to remove the sheath without dislodging it. We were able to suture the the lead to the chestwall, flush the pocket with antibiotic solution, place the right atrial lead through a 7-French sheath using a combination of curved and straight eyelets. Appropriate thresholds and impedance were found. High voltage did not stimulate the diaphragm either in RA, RV, or LV.
Thereafter, we sutured all the leads down to the chest wall, placed the device into the pocket, and also sutured it down. We did not do any PFT testing because of the patient's overall comorbities. We closed the pocket with running 2-0 and 4-0 Monocryl after we flushed the pocket with antibiotic solution and a Floseal device. Running 2-0 and 4-0 Monocryl closed the biventricular AICD, and Dermabond was placed superficially. The patient tolerated the procedure uneventfully.
We explanted the device on the left side and placed a cap over the AICD, closed the empty device pocket with running2-0 and 4-0 Monocryl and flushed the pocket with antibiotic solution and Ancef powder.
Thank you in advance.
Post Procedure Diagnoses:
1) Successful implantation of biventricular automatic implantable cardioverter-defibrillator in the right side.
2) Succesful implantation of right atrial lead, St. Jude Medical.
3)Succesful implantation of right ventricular lead, St. Jude medical.
4) Succesful implantation of left ventricular lead, St. Jude medical.
5)Explantation of the automatic implantable cardioverter-defibrillator single-chamber on the left side.
6)Venous occlusion, 100% in the left subclavian vein with collaterization.
7)Ischemic heart disease.
8)Heart failure, class III
Procedure Performed:
Indications: The patient is a very pleasant 79 year old gentleman with a history of ischemic cardiomyopathy, bradycardia, QRS of 130 msec. AICD has approached end of life, here for upgrade of his device to a biventricular AICD.
Procedure in detail: The risks and benefits were explained to the patient, risks of death, MI, stroke,bleeding, infections less than 1%, the patient was taken to the EP lab in a fasting state and prepped in the usual sterile fashion.
A venogram of the left chest wall was made and showed there was 100% occlusion of the left subclavian vein with collaterization. Therefore we went ahead and reprepped the right chest wall, we did a venogram and we found appropriate subclavian vein. Using a combination of blunt and sharp dissection,we opened up the AICD pocket, and using the venogram with a 19-gauge needle, We accessed the right subclavian vein. We did this twice. We placed a 9- French sheath in the right sublcavian vein. A combination of curved and straight stylets was used to place the RV lead in the RV apex. Thereafter, using the Biosense Webster EP catheter with a straight system catheter we were able to cannulate the coronary sinus. We did a venogram of the coronary sinus. We found a large posterolateral vein coming off the main coronary sinus. We found a large posterolateral vein coming off the main coronary sinus. We were able to cannulate it with the aid of a 0.032 wire. We placed a quad-lead St. Jude medical into the posterolateral vein. Appropriate thresholds and impedance were found. We were able to remove the sheath without dislodging it. We were able to suture the the lead to the chestwall, flush the pocket with antibiotic solution, place the right atrial lead through a 7-French sheath using a combination of curved and straight eyelets. Appropriate thresholds and impedance were found. High voltage did not stimulate the diaphragm either in RA, RV, or LV.
Thereafter, we sutured all the leads down to the chest wall, placed the device into the pocket, and also sutured it down. We did not do any PFT testing because of the patient's overall comorbities. We closed the pocket with running 2-0 and 4-0 Monocryl after we flushed the pocket with antibiotic solution and a Floseal device. Running 2-0 and 4-0 Monocryl closed the biventricular AICD, and Dermabond was placed superficially. The patient tolerated the procedure uneventfully.
We explanted the device on the left side and placed a cap over the AICD, closed the empty device pocket with running2-0 and 4-0 Monocryl and flushed the pocket with antibiotic solution and Ancef powder.