lcouto
Networker
Hoping to get some help on this.. Haven't billed one in quite a while and I'm a little rusty.. I'm thinking that it might be CPT Code 33229 but not quite sure:
Pre-procedure Diagnoses
1. Pacemaker lead failure, initial encounter
2. Pacemaker generator end of life
Procedures
1. REMOVAL AND REPLACEMENT OF PACEMAKER PULSE GENERATOR; MULTIPLE LEAD
2. INSERT / REPLACE / REMOVE PACEMAKER
BRIEF OPERATIVE NOTE
Pre-operative Diagnosis:
Pacemaker lead failure, initial encounter
Pacemaker generator end of life
Post-operative Diagnosis:
Same as above
Procedure Performed :
Implantation of Permanent Pacemaker
Implants and Procedure Description:
After informed consent was obtained, the patient was transported in a nonsedated condition to the cardiac catheterization suite. The patient was given moderate conscious sedation. The patient was prepped and draped in a sterile fashion and a "timeout" was taken.
Lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the right pectoralis muscle. Sharp incision was made in the skin. Utilizing a combination of sharp and blunt dissection, the old pulse generator was dissected from its pocket in the prepectoral fascia.
The generator was removed and the leads were tested. The ventricular lead was fractured by external testing and capped and secured to the pectoralis muscle with non-resorbable suture. The atrial lead was an active fixation lead. It was tested and found to have F waves of 1.0 mV, impedance 719 ohms, threshold was AF volts, current AF milliamps.
The patient was placed in Trendelenburg position. Percutaneous access was obtained in the subclavian vein utilizing the modified Seldinger technique. An .035 wire was advanced into the right atrium under fluoroscopic guidance. Over the .035 wire, an 7 French peel-away sheath was advanced. The wire and dilator were exchanged then for the ventricular pacing lead. The lead was a passsive fixation lead Utilizing curved and straight stylettes, the lead was positioned and secured in the right ventricular apex. It was tested and found to have R waves of 17.6 mV, impedance 605 ohms, threshold was 0.4 volts, current 1.0 milliamps. Adequate slack was placed in the lead under fluoroscopic guidance. The lead was tested with output of 10 V and did not stimulate the diaphragm.
I then attached the new pulse generator . The leads and pulse generator were incorporated in the pocket. The pocket was copiously irrigated. The subcutaneous fascia was closed with interrupted Vicryl suture. The skin layer was closed with a subcuticular Vicryl stitch. Final fluoroscopy demonstrated adequate slack in the leads. The wound was dressed in a sterile fashion.
Pre-procedure Diagnoses
1. Pacemaker lead failure, initial encounter
2. Pacemaker generator end of life
Procedures
1. REMOVAL AND REPLACEMENT OF PACEMAKER PULSE GENERATOR; MULTIPLE LEAD
2. INSERT / REPLACE / REMOVE PACEMAKER
BRIEF OPERATIVE NOTE
Pre-operative Diagnosis:
Pacemaker lead failure, initial encounter
Pacemaker generator end of life
Post-operative Diagnosis:
Same as above
Procedure Performed :
Implantation of Permanent Pacemaker
Implants and Procedure Description:
After informed consent was obtained, the patient was transported in a nonsedated condition to the cardiac catheterization suite. The patient was given moderate conscious sedation. The patient was prepped and draped in a sterile fashion and a "timeout" was taken.
Lidocaine was used to infiltrate the skin and subcutaneous tissue overlying the right pectoralis muscle. Sharp incision was made in the skin. Utilizing a combination of sharp and blunt dissection, the old pulse generator was dissected from its pocket in the prepectoral fascia.
The generator was removed and the leads were tested. The ventricular lead was fractured by external testing and capped and secured to the pectoralis muscle with non-resorbable suture. The atrial lead was an active fixation lead. It was tested and found to have F waves of 1.0 mV, impedance 719 ohms, threshold was AF volts, current AF milliamps.
The patient was placed in Trendelenburg position. Percutaneous access was obtained in the subclavian vein utilizing the modified Seldinger technique. An .035 wire was advanced into the right atrium under fluoroscopic guidance. Over the .035 wire, an 7 French peel-away sheath was advanced. The wire and dilator were exchanged then for the ventricular pacing lead. The lead was a passsive fixation lead Utilizing curved and straight stylettes, the lead was positioned and secured in the right ventricular apex. It was tested and found to have R waves of 17.6 mV, impedance 605 ohms, threshold was 0.4 volts, current 1.0 milliamps. Adequate slack was placed in the lead under fluoroscopic guidance. The lead was tested with output of 10 V and did not stimulate the diaphragm.
I then attached the new pulse generator . The leads and pulse generator were incorporated in the pocket. The pocket was copiously irrigated. The subcutaneous fascia was closed with interrupted Vicryl suture. The skin layer was closed with a subcuticular Vicryl stitch. Final fluoroscopy demonstrated adequate slack in the leads. The wound was dressed in a sterile fashion.
