OPENSHAW
Guru
INDICATION: The patient present for a PG replacement because his device is at ERI. He will also under go placement of a new RV lead since the threshold of his current 15 year old lead is rising to unacceptable levels.
PROCEDURE:
Remove old PG
Cap old lead
Insert new RV lead
Implant new PG
Pocket modification
NARRATIVE:
Following premedication with IV and PO antibiotics, the patient was taken to the laboratory and the left pectoral area prepared and draped.30 cc's of 1% lidocaine were infiltrated and a 3.5cm incision was made along the strap line beginning at the junction of the mid and lateral third of the clavicle. Dissection was carried down to the pectoralis fascia and bleeding was controlled with cautery. A pocket of sufficient size to contain the pulse generator and leads was developed with blunt and sharp dissection. The patient was then placed in the Trendelenberg position and an 18G thinwalled needle was inserted into the subclavian vein which had been previously identified and found suitable for implant with the injection of 20cc's of iodinated contrast. A Wholey wire was passed to the RA after an initial stick was unsuccessful in negotiating the subclavian/innominate junction. A 7F peel-away valved sheath was inserted over the Wholey guide wire. A bipolar positive fixation bipolar lead was inserted and with the use of curved and straight stylets was positioned in the RVOT where good sensing and pacing parameters were obtained and no abnormal stimulation was noted at a maximum output of 10 volts.. The lead was fixed to the pectoralis fascia with 2.0 silk. Two silk purse string sutures were required to control oozing into the pocket. The old lead was disconnected and capped. The new lead was attached to the new PG. After more pocket modification, it was flushed with antibiotic solution. The pulse generator and leads were carefully placed in the pocket, Arixtra was applied,and, following a final flouroscopic check, the pocket was closed with interrupted 2.0 Vicryl, continuous 2.0 Vicryl, and stainless steel staples. A sterile dressing was applied and the patient was sent to the recovery area.
EP DATA:
Right Ventricle: Bipolar Threshold @PW 0.5ms: 1.4V Impedance: 545 Ohms R wave: 3.9mV
IMPLANTED DATA:
Pulse Generator: St. Jude Medical Model no: Serial no:
Date of implant: 3/24/2014
Ventricular Lead: St. Jude Medical Model no: Serial no:
Date of implant: 3/24/2014
Capped Lead: St. Jude Medical Model no: Serial no: Date of Implant: 5/22/2003.
COMPLICATIONS: None
SPECIMEN:
Old PG (explanted): St. Jude Medical Model no: Serial No:
Date of implant: 9/22/2003
ESTIMATED BLOOD LOSS: 20cc
FLOUROSCOPIC DOSE: Please see lab protocol.
Would this be coded as:
33207, Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular
and
33233, Removal of permanent pacemaker pulse generator only
The diagnosis code is V53.31
Thank yaw!!!!!!
PROCEDURE:
Remove old PG
Cap old lead
Insert new RV lead
Implant new PG
Pocket modification
NARRATIVE:
Following premedication with IV and PO antibiotics, the patient was taken to the laboratory and the left pectoral area prepared and draped.30 cc's of 1% lidocaine were infiltrated and a 3.5cm incision was made along the strap line beginning at the junction of the mid and lateral third of the clavicle. Dissection was carried down to the pectoralis fascia and bleeding was controlled with cautery. A pocket of sufficient size to contain the pulse generator and leads was developed with blunt and sharp dissection. The patient was then placed in the Trendelenberg position and an 18G thinwalled needle was inserted into the subclavian vein which had been previously identified and found suitable for implant with the injection of 20cc's of iodinated contrast. A Wholey wire was passed to the RA after an initial stick was unsuccessful in negotiating the subclavian/innominate junction. A 7F peel-away valved sheath was inserted over the Wholey guide wire. A bipolar positive fixation bipolar lead was inserted and with the use of curved and straight stylets was positioned in the RVOT where good sensing and pacing parameters were obtained and no abnormal stimulation was noted at a maximum output of 10 volts.. The lead was fixed to the pectoralis fascia with 2.0 silk. Two silk purse string sutures were required to control oozing into the pocket. The old lead was disconnected and capped. The new lead was attached to the new PG. After more pocket modification, it was flushed with antibiotic solution. The pulse generator and leads were carefully placed in the pocket, Arixtra was applied,and, following a final flouroscopic check, the pocket was closed with interrupted 2.0 Vicryl, continuous 2.0 Vicryl, and stainless steel staples. A sterile dressing was applied and the patient was sent to the recovery area.
EP DATA:
Right Ventricle: Bipolar Threshold @PW 0.5ms: 1.4V Impedance: 545 Ohms R wave: 3.9mV
IMPLANTED DATA:
Pulse Generator: St. Jude Medical Model no: Serial no:
Date of implant: 3/24/2014
Ventricular Lead: St. Jude Medical Model no: Serial no:
Date of implant: 3/24/2014
Capped Lead: St. Jude Medical Model no: Serial no: Date of Implant: 5/22/2003.
COMPLICATIONS: None
SPECIMEN:
Old PG (explanted): St. Jude Medical Model no: Serial No:
Date of implant: 9/22/2003
ESTIMATED BLOOD LOSS: 20cc
FLOUROSCOPIC DOSE: Please see lab protocol.
Would this be coded as:
33207, Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular
and
33233, Removal of permanent pacemaker pulse generator only
The diagnosis code is V53.31
Thank yaw!!!!!!