Wiki reimplantation of ICD generator

[schmsuz]

Could someone please help with this procedure report? The physician was checking to see if there was any malfunctions of the leads and generator. He reinserted the same generator and leads....didn't replace anything. The pt presented with alerts from his device that suggested difficulties with increased resistance on the RV lead. Will I only be able to bill for the fluoroscopy? Thanks for any help you can give!


PROCEDURE:
1. Intraoperative assessment of chronic ICD and atrial leads.
2. Reimplantation of recent ICD generator.

PROCEDURAL METHOD:
After informed consent, the patient was brought to the catheterization laboratory.
The left subclavian ICD site was anesthetized with 1% Lidocaine. The left
subclavian ICD pocket was easily opened. The old generator was evaluated at the
time of removal from the pocket. There was no evidence for any visual insulation
breaks on any of the leads. All 4 of the set screws were reevaluated. The right
ventricular pacer lead was snug but not tight. All four of the leads were then
removed from the ICD generator and further investigated and electronically
interrogated. Direct measurement resulted in normal resistance. Fluoroscopically
the leads were carefully evaluated. On documented cinefluoroscopy there was no
evidence for any insulation breaks. The leads were then freed up cautiously within
the fibrous pocket. There was no visualization of any abnormalities. The sets
screws were themselves further evaluated and functioning appropriately. The leads
were then carefully connected back into the generator. All pins were visualized as
fully seated. This set screws were tightened appropriately. Reevaluation
electronically demonstrated normal electrical resistance. This was checked many
times during the reimplantation process without any abnormalities noted.
Furthermore, the generator was manipulated within the pocket with consistent normal
readings. The individual leads were also manipulated with normal readings. Lastly,
the plastic header the generator was twisted gently and no abnormal readings were
obtained. Defibrillatory threshold testing was not performed. The pocket was then
irrigated with antibiotic solution. The pocket was slightly modified to allow the
generator to reside within the pocket without any tension on the leads. The
subcutaneous tissue was then closed with multiple layers with 2-0 Vicryl. The skin
was closed with 4-0 Vicryl. The skin was sealed with Dermabond. There was no
bleeding or complications. The patient was transferred for routine post procedural
care.

 

[twizzle]

I think you could realistically bill for pocket revision (with a 52 and possibly with a 59 if bundled) although I'm not sure what Dx you would use (probably 996.72 as there was some fibrosis in the pocket). Also, repositioning of the leads as he did reposition them slightly (put it this way, they weren't in the same place as before the procedure) and tested them for appropriate placement (I would use modifier 52 again though). He should be paid for something as he did a lot of work. Insurance will want records for the 52 modifier for sure.
It's a tricky one but I think the report shows good documentation which is always helpful in these tricky cases.

 

[schmsuz]

Thank you for your help!