csorensen21@yahoo.com
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I am a little bit confused on how I should approach coding this pacemaker migration due to breast cancer. I was wondering if anyone had any pointers! Should I be coding for the excision and closure of the skin pockets as well as the pacemaker relocation code 33222???
Please help!
OP Report
The patient was taken to the cath lab. Both infraclavicular fossa were prepped and draped in the usual manner and were anesthetized with 1% lidocaine as well as the line between both. A 2-inch incision was placed above the site of the pacemaker generator. Using blunt dissection, the generator and the leads were freed from the underlying fascia. Using blunt dissection with fingers as well as slightly with the aid of tunneling device, I established connection between the left and right infraclavicular fossa. A 2-inch incision was made in the infraclavicular fossa on the right. A small pocket there was created using blunt dissection and connection was established within both pcokets. The atrial lead previously placed was connected to the atrial adapter. The atrial adapter was tunneled to the right side. The ventricular lead was then removed from the generator and connected to the external pacing device using sternal wires. The ventricular lead was tested. Note that the ventricular lead was also previously placed and it is a Medtronic Model. It was connected to the ventricular adaptor. It was then tunneled across to the other side and connected to the generator. During that time, the patient had intrinsic ventricular escape rhythm at 35 beats per minute. The generator was previously implanted and was capped. Both leads were screwed to the generator. Note that as soon as the leads were connected to the adapter, they were also screwed in place right away and the screws were sealed using the lubricant provided. At this point, the generator on the right side was secured to the underlying fascia using 0 silk sutures. The subcutaneous tissue on both sides was repaired using 3-0 Vicryl sutures and the skin was stapled in both incisions. She tolerated the procedure well.
Please help! Thank you!
Please help!
OP Report
The patient was taken to the cath lab. Both infraclavicular fossa were prepped and draped in the usual manner and were anesthetized with 1% lidocaine as well as the line between both. A 2-inch incision was placed above the site of the pacemaker generator. Using blunt dissection, the generator and the leads were freed from the underlying fascia. Using blunt dissection with fingers as well as slightly with the aid of tunneling device, I established connection between the left and right infraclavicular fossa. A 2-inch incision was made in the infraclavicular fossa on the right. A small pocket there was created using blunt dissection and connection was established within both pcokets. The atrial lead previously placed was connected to the atrial adapter. The atrial adapter was tunneled to the right side. The ventricular lead was then removed from the generator and connected to the external pacing device using sternal wires. The ventricular lead was tested. Note that the ventricular lead was also previously placed and it is a Medtronic Model. It was connected to the ventricular adaptor. It was then tunneled across to the other side and connected to the generator. During that time, the patient had intrinsic ventricular escape rhythm at 35 beats per minute. The generator was previously implanted and was capped. Both leads were screwed to the generator. Note that as soon as the leads were connected to the adapter, they were also screwed in place right away and the screws were sealed using the lubricant provided. At this point, the generator on the right side was secured to the underlying fascia using 0 silk sutures. The subcutaneous tissue on both sides was repaired using 3-0 Vicryl sutures and the skin was stapled in both incisions. She tolerated the procedure well.
Please help! Thank you!