Lisa Bledsoe
True Blue
Patient has a previously placed dual chamber generator with only the atrial lead in place because when it was originally inserted, the ventrical lead had to be withdrawn because of perforation; therefore there was only one lead in use, the ventricular lead port on the dual chamber generator had a pin placed in it. Patient eventually presented to my physician in a-fib and documented end of life battery. My physician placed a new dual chamber generator and ventricular lead, did not replace the atrial lead. We have differing thoughts on how to code this, so I am requesting help from the forum. It is a very lengthy op note, so I will paraphrase/highlight the best I can:
Procedure Performed: RV lead placement, pacemaker generator change, pacemaker pocket revision. I recommended that we place a new ventricular lead and change out the nonfunctional pacemaker, which had also reached end of life. I did not plan on extracting the atrial lead given the increased risk of perforation. ...ventricular lead was then advanced into the superior vena cava and inferior vena cava using fluoroscopic guidance...the lead was visualized in the LAO and RAO views with excellent placement noted in both views...sutured into place...blunt dissection was used to form a new pocket for the pacemaker generator in a more lateral fashion. The leads were attached to the new pacemaker generator...
One opinion is to code 33214 as an upgrade to dual chamber.
Another opinion is to code 33207, 33233, 33222-59
Any thoughts? And if references can be provided that would be helpful.
Thank you!!
Procedure Performed: RV lead placement, pacemaker generator change, pacemaker pocket revision. I recommended that we place a new ventricular lead and change out the nonfunctional pacemaker, which had also reached end of life. I did not plan on extracting the atrial lead given the increased risk of perforation. ...ventricular lead was then advanced into the superior vena cava and inferior vena cava using fluoroscopic guidance...the lead was visualized in the LAO and RAO views with excellent placement noted in both views...sutured into place...blunt dissection was used to form a new pocket for the pacemaker generator in a more lateral fashion. The leads were attached to the new pacemaker generator...
One opinion is to code 33214 as an upgrade to dual chamber.
Another opinion is to code 33207, 33233, 33222-59
Any thoughts? And if references can be provided that would be helpful.
Thank you!!