bevann0402@bellsouth.net
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having trouble with which cpt code to use. I know I will add mod 52 to it.
here is the report I got from the doctor:
indication:
this is severe cardiomyopathy with patient requiring both outpatient and inpatient CHF treatments with severe cardiomyopathy noted, nonischemic, recent cardiac catheterization showing nonobstructive CAD. the patient was recommended upgrade to Bi-V ICD to correct cardiac dyssynchrony. blood loss less than 30 cc.
the details of Bi-V upgrade explained. patient prepped and draped in the usual fashion with attention to use iodine drape to the left chest wall. ancef 2 g IV piggyback was running on call. next lidocaine was used to numb up the pacemaker device. there was some excessive swelling, but the patient reported that this was unchanged from implant. incision is made, not through the entire pacemaker but just through the skin and several of the fat layers. Bovie and cautery were used to control bleeding. a slight more cut into the pacemaker pocket revealed an excessive amount of fluid; I would probably say somewhere around 80 to 100 cc of serosanguineous fluid that came out from the pacemaker site.
the decision was made to HALT the upgrade to the Bi-V device in case we had a pacemaker infection.
there was some mild tenderness to the pacemaker pocket when the patient first arrived, but no obvious infection. I did not see any frank pus in the layers of the pacemaker device that I dissected to. there were cultures x 2 taken of the device. the pacemaker incision was thoroughly flushed utilizing the antibiotic solution. please see pharmacy orders for details.
the decision is made to close the pocket up. there is a long, running stitch made in a little bit of the deeper subcu tissue and then the skin layer was closed utilizing interrupted staples. I never did see the pacemaker wires and the pacemaker device was not visualized. the incision was never made into the complete pacemaker device. the patient left the lab in stable condition with recommendations for Ancef 2 g IV piggyback q.8 hours times a total of 3 doses. if the pacemaker is found not to be infected, he can return at a later date to undergo upgrade. if the pacemaker device is infected, he will be referred over to id and IV antibiotics will be required and extended for 4-6 weeks prior to upgrade or prior to excision of the device.
is this enough to code from or should is query the physician?
thanks in advance for the help.
Beverly
here is the report I got from the doctor:
indication:
this is severe cardiomyopathy with patient requiring both outpatient and inpatient CHF treatments with severe cardiomyopathy noted, nonischemic, recent cardiac catheterization showing nonobstructive CAD. the patient was recommended upgrade to Bi-V ICD to correct cardiac dyssynchrony. blood loss less than 30 cc.
the details of Bi-V upgrade explained. patient prepped and draped in the usual fashion with attention to use iodine drape to the left chest wall. ancef 2 g IV piggyback was running on call. next lidocaine was used to numb up the pacemaker device. there was some excessive swelling, but the patient reported that this was unchanged from implant. incision is made, not through the entire pacemaker but just through the skin and several of the fat layers. Bovie and cautery were used to control bleeding. a slight more cut into the pacemaker pocket revealed an excessive amount of fluid; I would probably say somewhere around 80 to 100 cc of serosanguineous fluid that came out from the pacemaker site.
the decision was made to HALT the upgrade to the Bi-V device in case we had a pacemaker infection.
there was some mild tenderness to the pacemaker pocket when the patient first arrived, but no obvious infection. I did not see any frank pus in the layers of the pacemaker device that I dissected to. there were cultures x 2 taken of the device. the pacemaker incision was thoroughly flushed utilizing the antibiotic solution. please see pharmacy orders for details.
the decision is made to close the pocket up. there is a long, running stitch made in a little bit of the deeper subcu tissue and then the skin layer was closed utilizing interrupted staples. I never did see the pacemaker wires and the pacemaker device was not visualized. the incision was never made into the complete pacemaker device. the patient left the lab in stable condition with recommendations for Ancef 2 g IV piggyback q.8 hours times a total of 3 doses. if the pacemaker is found not to be infected, he can return at a later date to undergo upgrade. if the pacemaker device is infected, he will be referred over to id and IV antibiotics will be required and extended for 4-6 weeks prior to upgrade or prior to excision of the device.
is this enough to code from or should is query the physician?
thanks in advance for the help.
Beverly