drhoads
Guru
Please help coding procedure: Placement of two epicardial left ventricular leads via a left anterior thoracotomy with tunneling to pocket and replacement of generator.
Description of procedure: Small left anterior thoracotomy was performed below the nipple in approx the 45h interspace. This was carried down with Bovie electrocautery o the ribs and the thorax was entered on the 4th interspace on top of the 5th rib. The intercostals were divided medially and laterally to the midaxillary line. The pericardium was identified. The anterior pericardial fat was debrided and a small window was made int he t pericardium over the anterolateral surface of the left ventricle. Two left ventricular leads were then screwed in place and tested and found to have acceptable numbers. These were both then tunneled through the subcutaneous tissue of the anterior chest to the pocked. The pocked was opened with a 15 blade and the generator was removed. The leads were disconnected form the generator. The previous left ventricular lead was capped. The new generator was brought up into the operative field. The left ventricular, right ventricular and atrial leads were all connected then without complication. The generator was then tested and found to have excellent numbers. The second left ventricular lead was capped. The generator and all the wires were then returned to the pocket. Hemostasis was achieved throughout all the incisions with bovie electrocautery and small silver clips as necessary. The pocket was closed in layers with 2-0 vicryl for the subcutanous fascia and 4-0 monocryl running subcuticular stitch for the skin.
A single blake drain was placed in the left thorax and brought out through separate stab incision. The anterior thoracotomy incision was then closed in layers.
Any assistance in coding this procedure would be greatly appreciated.
Description of procedure: Small left anterior thoracotomy was performed below the nipple in approx the 45h interspace. This was carried down with Bovie electrocautery o the ribs and the thorax was entered on the 4th interspace on top of the 5th rib. The intercostals were divided medially and laterally to the midaxillary line. The pericardium was identified. The anterior pericardial fat was debrided and a small window was made int he t pericardium over the anterolateral surface of the left ventricle. Two left ventricular leads were then screwed in place and tested and found to have acceptable numbers. These were both then tunneled through the subcutaneous tissue of the anterior chest to the pocked. The pocked was opened with a 15 blade and the generator was removed. The leads were disconnected form the generator. The previous left ventricular lead was capped. The new generator was brought up into the operative field. The left ventricular, right ventricular and atrial leads were all connected then without complication. The generator was then tested and found to have excellent numbers. The second left ventricular lead was capped. The generator and all the wires were then returned to the pocket. Hemostasis was achieved throughout all the incisions with bovie electrocautery and small silver clips as necessary. The pocket was closed in layers with 2-0 vicryl for the subcutanous fascia and 4-0 monocryl running subcuticular stitch for the skin.
A single blake drain was placed in the left thorax and brought out through separate stab incision. The anterior thoracotomy incision was then closed in layers.
Any assistance in coding this procedure would be greatly appreciated.