adrianne84
New
I am unsure about what CPT codes to use for this case. I considered 33999 (compared to 33202) and 93287 x 2. Can someone please help?
PROCEDURES PERFORMED:
1. Revision of epicardial left ventricular lead.
2. Extensive epicardial mapping for best placement with Medtronic mapping tool.
3. Periprocedural reprogramming of ICD.
OPERATIVE TECHNIQUE IN DETAIL:
The patient was brought to the operating room, placed on the operative table in
supine position. After successful establishment of double-lumen general
endotracheal anesthesia, the patient had a bump placed under left side, she was
prepped, positioned, and draped in usual sterile fashion. Surgical timeout was
performed, surgical imaging have been reviewed. Next, the previous submammary
incision was reopened. A redo thoracotomy was performed. A soft tissue
retractor and a gentle chest retractor placed. The previous fibrinous exudate
was carefully removed. The phrenic nerve was again identified, the previous
leads were intact on the epicardium, but the patient had previous pericarditis
and there were areas of the heart muscle that were not able to be adequately
dissected out. We, at this time, did a deeper dissection into bleeding muscle,
placed the first catheter lead got 2 volt threshold rather at 1 millisecond. We
then tried 8 other locations for the other anode lead of the bipolar lead
system. Finally, we settled on one apical area that gave us sub 3 thresholds.
Final thresholds on the left ventricular lead which is model #4968-35, serial
#LEN426788V was a configuration of tip to coil with a threshold of 3.25 volts at
1 millisecond giving us an estimated battery life of greater than 7 years. No
DFT testing was done. The implantable cardioverter-defibrillator device was
programmed from a biventricular mode into an RV pacing only mode with shock
therapies off. We then turned shock therapies back on. We put it back into the
DDDR mode with a lower rate of 60, upper tracking rate of 130, upper activity
rate of 120. We had good atrial amplitudes of 1.5 volts, pulse width of 0.4
milliseconds, sensitivity 0.3 millivolts. Right ventricular lead had amplitude
2 volts with a pulse width of 0.4 milliseconds and sensitivity 0.3 millivolts
and the left ventricular lead had amplitude of 4 volts with a pulse width of 1
millisecond. Final configuration was from ventricular tip to RV coil, bipolar
mode was turned on. The patient tolerated the procedure well. We irrigated
out. We positioned a 19-French Blake drain, reinflated the left lung, put a
figure-of-eight pericostal suture, infiltrated 40 mL of 1% lidocaine with
epinephrine and closed the soft tissues with Vicryl, skin with Monocryl.
Dermabond and sterile dressing were applied. The patient was taken from the
operating room to the PACU in stable condition. The patient's family was
notified.
PROCEDURES PERFORMED:
1. Revision of epicardial left ventricular lead.
2. Extensive epicardial mapping for best placement with Medtronic mapping tool.
3. Periprocedural reprogramming of ICD.
OPERATIVE TECHNIQUE IN DETAIL:
The patient was brought to the operating room, placed on the operative table in
supine position. After successful establishment of double-lumen general
endotracheal anesthesia, the patient had a bump placed under left side, she was
prepped, positioned, and draped in usual sterile fashion. Surgical timeout was
performed, surgical imaging have been reviewed. Next, the previous submammary
incision was reopened. A redo thoracotomy was performed. A soft tissue
retractor and a gentle chest retractor placed. The previous fibrinous exudate
was carefully removed. The phrenic nerve was again identified, the previous
leads were intact on the epicardium, but the patient had previous pericarditis
and there were areas of the heart muscle that were not able to be adequately
dissected out. We, at this time, did a deeper dissection into bleeding muscle,
placed the first catheter lead got 2 volt threshold rather at 1 millisecond. We
then tried 8 other locations for the other anode lead of the bipolar lead
system. Finally, we settled on one apical area that gave us sub 3 thresholds.
Final thresholds on the left ventricular lead which is model #4968-35, serial
#LEN426788V was a configuration of tip to coil with a threshold of 3.25 volts at
1 millisecond giving us an estimated battery life of greater than 7 years. No
DFT testing was done. The implantable cardioverter-defibrillator device was
programmed from a biventricular mode into an RV pacing only mode with shock
therapies off. We then turned shock therapies back on. We put it back into the
DDDR mode with a lower rate of 60, upper tracking rate of 130, upper activity
rate of 120. We had good atrial amplitudes of 1.5 volts, pulse width of 0.4
milliseconds, sensitivity 0.3 millivolts. Right ventricular lead had amplitude
2 volts with a pulse width of 0.4 milliseconds and sensitivity 0.3 millivolts
and the left ventricular lead had amplitude of 4 volts with a pulse width of 1
millisecond. Final configuration was from ventricular tip to RV coil, bipolar
mode was turned on. The patient tolerated the procedure well. We irrigated
out. We positioned a 19-French Blake drain, reinflated the left lung, put a
figure-of-eight pericostal suture, infiltrated 40 mL of 1% lidocaine with
epinephrine and closed the soft tissues with Vicryl, skin with Monocryl.
Dermabond and sterile dressing were applied. The patient was taken from the
operating room to the PACU in stable condition. The patient's family was
notified.