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removal of implantable loop recorder and pacemaker coding

Parul Posted Tue 27th of November, 2012 18:41:12 PM

Hi All, Appreciate your help in coding this. I am new to pacemaker coding. TIA.

The patient was prepped and draped in the usual fashion. An loban was used. After a timeout, the skin was infiltrated over 2 marked areas where the intent had been to remove the Reveal and also implant the pacemaker. The Reveal monitor was removed first by incising over the existing scar through a combination of sharp and blunt dissection, removing the generator from under the skin. This pocket was irrigated and approximated with 3-0 Vicryl and a subcuticular layer of 4-0 Monocryl. The patient was then prepped for a cephalic vein cutdown. The skin was infiltrated with Carbocaine over the deltopectoral groove and a cephalic vein cutdown performed.
No cephalic vein was isolated and a subclavian puncture was done using 2 safe sheaths to access thje central circulation. Through this, a 000model ventricular lead was advanced to the right ventricular apex where R-waves measured…threshold was 0.6 volts and impedance was 1050ohms. The lead was fixed to the subcutaneous facia using Ethibond. Through the second safe sheath, an atrial lead which was a 000model lead was advanced to the high rate atrium. The atrial appendage was entered using a preformed guidewire. When acceptable parameters were found, the lead was screwed into position. Both leads were confirmed in their respective positions by RAO and LAO fluoroscopy. The lead was fixed. Additional slack was added to both leads because of tortuosity in the venous system. …..the pocket was closed with two layers of suture…the patient tolerated the procedure well.

SuperCoder Answered Wed 28th of November, 2012 02:42:53 AM


We are working on this and will post the answer soon.


SuperCoder Answered Thu 29th of November, 2012 03:31:47 AM

It looks like the ILR was removed (33284) and then only pacemaker leads were inserted (no generator), so look to 33217 for insertion of 2 transvenous leads. If documentation also shows insertion of generator, then the coding would change (e.g., 33208 instead of 33217).

Hope that helps!

Parul Posted Thu 29th of November, 2012 15:04:39 PM

Thanks a lot! You are awesome.:)

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