ablythe
Networker
I do not know how to code for this sub-Q lead revision.
To me it doesn't look like a lead repositioning or a skin pocket relocation.
Is there a code for this? Or do we need an unlisted code? (And if so, what would be a comparable code?)
Thanks for any help that can be provided.
Procedure:
Lead revision, subcutaneous ICD
Brief history:
The patient is a 37-year-old gentleman with dilated cardiomyopathy, ejection fraction 35%, persistent atrial fibrillation, and subcutaneous ICD implanted in August at Portsmouth regional hospital for secondary prevention after presenting with sustained ventricular tachycardia and collapse. He recently transferred his device care to this clinic. 2 days ago he was noted to have an alert with an out of range impedance greater than 400 ohms. Lateral chest x-ray was concerning for lead withdrawal from the device header. He is referred for lead revision.
Procedure description:
The patient was brought to the electrophysiology lab in the fasting state. Informed consent was obtained and the rationale for the procedure was explained in detail to the patient. 3 g of Ancef was given as antibiotic prophylaxis. A timeout was performed upon arrival. The patient was given general anesthesia. The left lateral chest was meticulously prepped and draped in the usual sterile fashion. A lateral incision was made over the site of the prior incision and carried to the rib fascia using blunt and sharp dissection. The device was felt with palpation and gently freed from the pre-existing pocket beneath the latissimus dorsi muscle at the lateral extent to the pocket. Hemostasis was ensured with electrocautery. The device was freed from the surrounding tissue and delivered from the pocket. The header was carefully inspected and the pin was noted to be retracted approximately 1.5 mm. The pulse generator was removed from the header, the pin and header was cleaned, and the lead was reinserted into the header and secured, ensuring that the pin was properly secured within the header and multiple views. The pulse generator was placed back into the pocket and secured to the rib fascia with a stay suture. The incision was closed in layers using 2 oh V-Loc and a subcuticular layer using 4-0 Vicryl. A dry sterile dressing was placed over the incision.
To me it doesn't look like a lead repositioning or a skin pocket relocation.
Is there a code for this? Or do we need an unlisted code? (And if so, what would be a comparable code?)
Thanks for any help that can be provided.
Procedure:
Lead revision, subcutaneous ICD
Brief history:
The patient is a 37-year-old gentleman with dilated cardiomyopathy, ejection fraction 35%, persistent atrial fibrillation, and subcutaneous ICD implanted in August at Portsmouth regional hospital for secondary prevention after presenting with sustained ventricular tachycardia and collapse. He recently transferred his device care to this clinic. 2 days ago he was noted to have an alert with an out of range impedance greater than 400 ohms. Lateral chest x-ray was concerning for lead withdrawal from the device header. He is referred for lead revision.
Procedure description:
The patient was brought to the electrophysiology lab in the fasting state. Informed consent was obtained and the rationale for the procedure was explained in detail to the patient. 3 g of Ancef was given as antibiotic prophylaxis. A timeout was performed upon arrival. The patient was given general anesthesia. The left lateral chest was meticulously prepped and draped in the usual sterile fashion. A lateral incision was made over the site of the prior incision and carried to the rib fascia using blunt and sharp dissection. The device was felt with palpation and gently freed from the pre-existing pocket beneath the latissimus dorsi muscle at the lateral extent to the pocket. Hemostasis was ensured with electrocautery. The device was freed from the surrounding tissue and delivered from the pocket. The header was carefully inspected and the pin was noted to be retracted approximately 1.5 mm. The pulse generator was removed from the header, the pin and header was cleaned, and the lead was reinserted into the header and secured, ensuring that the pin was properly secured within the header and multiple views. The pulse generator was placed back into the pocket and secured to the rib fascia with a stay suture. The incision was closed in layers using 2 oh V-Loc and a subcuticular layer using 4-0 Vicryl. A dry sterile dressing was placed over the incision.