lcouto
Networker
New to coding need some assistance please..... Would this be just a 33207(Surgeon did removal of pulse generator and leads)
Pre-procedure Diagnoses
1. Pacemaker lead failure
2. Pacemaker end of life
Post-procedure Diagnoses
1. Subclavian vein obstruction with collaterals
2. Pacemaker lead failure
3. Pacemaker end of life
Procedures
1. FL VENOGRAM EXTREMITY LEFT
2. PCI (CATH LAB)
3. HC PACER LEAD: CORTISS 4 - 6 FR
ACCESS and POCKET FORMATION:
Dr. X carefully dissected the old pulse generator and leads from the pacer pocket. For details of the surgical procedure, please see his separately dictated note. The patient was placed in Trendelenburg position. Percutaneous access was obtained in the Axillary vein utilizing the modified Seldinger technique. An .035 J wire was advanced into the subclavian artery, however it would not cross into the superior vena cava. I therefore placed the 8 French dilator over the 035 wire into the axillary vein. We performed a non-ST to assess the patency of the left subclavian vein. I found the left subclavian vein to have a short chronic total occlusion with reconstitution of the subclavian vein distally via collateral vessels. Rather than a band in the atrial lead and pocket, the decision was made to try to cross the occlusion in the left subclavian vein. I initially tried with a will require and then with an angled Glidewire. I was initially unable to cross the lesion. I then tried with a Confianza Pro 014 wire and then returned with the angled Glidewire. I was carefully able to cross the chronic total occlusion and then advanced a 5 French dilator over the glide wire across the total occlusion and the subclavian vein. I exchanged out the Glidewire further woolly wire. I then dilated with channel in the left subclavian vein by using larger dilators. I started with a 6 French an upsized to a 7 French dilator. I was then able to advance the 7 French peel away sheath and dilator into the superior vena cava. The wire and dilator were exchanged then for the ventricular pacing lead. The lead was an Passive fixation lead (Medtronic 4092-58 with serial number LEP521440V) 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 Paced mV, impedance 676 ohms, threshold was 0.4 volts, current 0.8 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.
Am I missing any other codes? Thank you for your help.
Pre-procedure Diagnoses
1. Pacemaker lead failure
2. Pacemaker end of life
Post-procedure Diagnoses
1. Subclavian vein obstruction with collaterals
2. Pacemaker lead failure
3. Pacemaker end of life
Procedures
1. FL VENOGRAM EXTREMITY LEFT
2. PCI (CATH LAB)
3. HC PACER LEAD: CORTISS 4 - 6 FR
ACCESS and POCKET FORMATION:
Dr. X carefully dissected the old pulse generator and leads from the pacer pocket. For details of the surgical procedure, please see his separately dictated note. The patient was placed in Trendelenburg position. Percutaneous access was obtained in the Axillary vein utilizing the modified Seldinger technique. An .035 J wire was advanced into the subclavian artery, however it would not cross into the superior vena cava. I therefore placed the 8 French dilator over the 035 wire into the axillary vein. We performed a non-ST to assess the patency of the left subclavian vein. I found the left subclavian vein to have a short chronic total occlusion with reconstitution of the subclavian vein distally via collateral vessels. Rather than a band in the atrial lead and pocket, the decision was made to try to cross the occlusion in the left subclavian vein. I initially tried with a will require and then with an angled Glidewire. I was initially unable to cross the lesion. I then tried with a Confianza Pro 014 wire and then returned with the angled Glidewire. I was carefully able to cross the chronic total occlusion and then advanced a 5 French dilator over the glide wire across the total occlusion and the subclavian vein. I exchanged out the Glidewire further woolly wire. I then dilated with channel in the left subclavian vein by using larger dilators. I started with a 6 French an upsized to a 7 French dilator. I was then able to advance the 7 French peel away sheath and dilator into the superior vena cava. The wire and dilator were exchanged then for the ventricular pacing lead. The lead was an Passive fixation lead (Medtronic 4092-58 with serial number LEP521440V) 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 Paced mV, impedance 676 ohms, threshold was 0.4 volts, current 0.8 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.
Am I missing any other codes? Thank you for your help.