CPCCODERII
Guest
Our provider started an ICD implantation, but due to abnormalities of the patients arterys, it was felt best to discontinue the procedure. I am thinking of coding as 33249-53, but am unsure if enough work was done to report the 33249? Please see OP note:
PROCEDURE DETAILS:
After the EP study, the patient was transferred to the cath lab for the ICD procedure. Anesthesia Service was utilized. Standard sterilization procedure was performed. The patient was prepped and draped in a routine sterile fastion. Lidocaine was used for local anesthesia. The ICD pocket was created in the left upper chest. Electrocautery was used for hemostasis. Finger blunt dissection was used for pocket creation. 10 cc constrast dye was injected first to visualize the axillary and subclavian veins. The venous puncture was performed. The axillary vein was accessed. However, the wire could not go further. It was going down to the left side of the heart. At this moment, we rechecked the sublavian venogram and it was found has persistent SVC. The procedure halted at this moment. The right side IV was started. 10 cc contrast dye was injected to visualize the right side of the subclavian and axillary veins. No blockage in the subclavian vein on the right side. Another 10 cc contrast dye was injected again to visualize the right atrium and SVC. It was noticed that the patient has an anomalous SVC on the right side, too. It seems that the right side SVC is very prolonged, tunneled down all the way to the bottom of the right atrium. It is unclear whether or not is connected to the IVC or joined at the IVC entrance to the lower part of the right atrium. Because the anatomy is unclear, for safety considerations I terminated the procedure. I will get a CT angiogram to get a clear anatomy. On the left side the pocket was flushed with vancomycin diluted normal saline. The pocket was closed with the 2-0 and 4-0 polysorb suture line.
Any help is appreciated!!
PROCEDURE DETAILS:
After the EP study, the patient was transferred to the cath lab for the ICD procedure. Anesthesia Service was utilized. Standard sterilization procedure was performed. The patient was prepped and draped in a routine sterile fastion. Lidocaine was used for local anesthesia. The ICD pocket was created in the left upper chest. Electrocautery was used for hemostasis. Finger blunt dissection was used for pocket creation. 10 cc constrast dye was injected first to visualize the axillary and subclavian veins. The venous puncture was performed. The axillary vein was accessed. However, the wire could not go further. It was going down to the left side of the heart. At this moment, we rechecked the sublavian venogram and it was found has persistent SVC. The procedure halted at this moment. The right side IV was started. 10 cc contrast dye was injected to visualize the right side of the subclavian and axillary veins. No blockage in the subclavian vein on the right side. Another 10 cc contrast dye was injected again to visualize the right atrium and SVC. It was noticed that the patient has an anomalous SVC on the right side, too. It seems that the right side SVC is very prolonged, tunneled down all the way to the bottom of the right atrium. It is unclear whether or not is connected to the IVC or joined at the IVC entrance to the lower part of the right atrium. Because the anatomy is unclear, for safety considerations I terminated the procedure. I will get a CT angiogram to get a clear anatomy. On the left side the pocket was flushed with vancomycin diluted normal saline. The pocket was closed with the 2-0 and 4-0 polysorb suture line.
Any help is appreciated!!