Can I bill 33215 twice since 2 leads were repositioned? And since it was only a lead repositioning and a lead placement and not a full ICD placement, can I bill separately for the coronary sinus venogram? If so, is this right?
33224, 33215x2, 36215, 75820-26.
PROCEDURES: Are as follows:
1. Right ventricular apical defibrillation lead repositioning.
2. Right atrial lead repositioning.
3. Coronary sinus venogram.
4. Coronary sinus lead placement.
INDICATIONS: The patient recently underwent an attempt at BiV-ICD placement. The procedure was complicated by coronary sinus perforation, and the procedure was aborted. We are now scheduled to again return to an attempt at placing the left coronary sinus lead.
DESCRIPTION OF PROCEDURE: Informed consent was obtained. A CRNA was in attendance for general sedation and local anesthesia was used. The left
infraclavicular incision was opened and the device was removed. The
ventricular lead was repositioned to a position in the inferior aspect of the
right ventricular apex. The lead was secured using an anchoring sleeve and 2
subcutaneous sutures. We then also repositioned the atrial lead into the
right atrial appendage, and the lead was also secured using 2 anchoring
sleeves. A long sheath was then introduced into the left subclavian vein.
Through this, a quadripolar mapping catheter was advanced, and the coronary
sinus was mapped and entered. The long sheath was threaded over the mapping catheter, which was then removed and replaced with a 6-French balloon-tipped catheter. A coronary sinus venogram was obtained, which showed a very large apical branch, and a small high posterolateral branch. We elected to try for the higher posterolateral branch, and a balloon-tipped catheter was removed
and replaced using a Medtronic 4298-88 lead. The lead was finally advanced
approximately 4 cm down from the coronary sinus. Excellent electrograms,
thresholds, and impedances were obtained with good sensing data. No
diaphragmatic pacing was noted at 10 volts. All equipment was carefully
removed and the lead was secured using an anchoring sleeve and 2 subcutaneous sutures. All leads were then reconnected with a previously employed Medtronic biventricular generator. Tug test on the tie-down site and the generator were all satisfactory. The generator was placed in the pocket, logo up, with redundant lead segments under the generator. The incision was closed in 3 layers. Steri-Strips were applied. Fluoroscopic visualization showed all 3 leads to still be in good position. No complications occurred during the procedure.
Any help would be greatly appreciated.
33224, 33215x2, 36215, 75820-26.
PROCEDURES: Are as follows:
1. Right ventricular apical defibrillation lead repositioning.
2. Right atrial lead repositioning.
3. Coronary sinus venogram.
4. Coronary sinus lead placement.
INDICATIONS: The patient recently underwent an attempt at BiV-ICD placement. The procedure was complicated by coronary sinus perforation, and the procedure was aborted. We are now scheduled to again return to an attempt at placing the left coronary sinus lead.
DESCRIPTION OF PROCEDURE: Informed consent was obtained. A CRNA was in attendance for general sedation and local anesthesia was used. The left
infraclavicular incision was opened and the device was removed. The
ventricular lead was repositioned to a position in the inferior aspect of the
right ventricular apex. The lead was secured using an anchoring sleeve and 2
subcutaneous sutures. We then also repositioned the atrial lead into the
right atrial appendage, and the lead was also secured using 2 anchoring
sleeves. A long sheath was then introduced into the left subclavian vein.
Through this, a quadripolar mapping catheter was advanced, and the coronary
sinus was mapped and entered. The long sheath was threaded over the mapping catheter, which was then removed and replaced with a 6-French balloon-tipped catheter. A coronary sinus venogram was obtained, which showed a very large apical branch, and a small high posterolateral branch. We elected to try for the higher posterolateral branch, and a balloon-tipped catheter was removed
and replaced using a Medtronic 4298-88 lead. The lead was finally advanced
approximately 4 cm down from the coronary sinus. Excellent electrograms,
thresholds, and impedances were obtained with good sensing data. No
diaphragmatic pacing was noted at 10 volts. All equipment was carefully
removed and the lead was secured using an anchoring sleeve and 2 subcutaneous sutures. All leads were then reconnected with a previously employed Medtronic biventricular generator. Tug test on the tie-down site and the generator were all satisfactory. The generator was placed in the pocket, logo up, with redundant lead segments under the generator. The incision was closed in 3 layers. Steri-Strips were applied. Fluoroscopic visualization showed all 3 leads to still be in good position. No complications occurred during the procedure.
Any help would be greatly appreciated.