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Code This!

Scenario Week of August 29, 2011:
View Current Scenario

The patient is a 72-year-old male who presents to an OPPS hospital for outpatient placement of a cardiac resynchronization therapy device.

Diagnosis: Left heart failure

Procedure: Insertion of a cardiac resynchronization therapy device with defibrillator

Procedure performed: Informed consent was obtained and risks and benefits were again explained. The patient was taken to the procedure room. Monitored anesthesia sedation was administered and was satisfactory throughout the procedure. The chest was prepped and draped in the usual sterile manner. Local anesthesia was achieved with 1 percent Lidocaine.

The subclavian vein was accessed. Under fluoroscopic guidance a guidewire was passed and positioned into the subclavian vein. Once the guidewire was in position, the pacer pocket was made on the left side of the chest using electrocautery and blunt dissection. No active bleeding was noted. An introducer and sheath were inserted through the guidewire into the subclavian vein. The introducer was removed and, through the sheath, ventricular leads were introduced and advanced under fluoroscopic guidance to the right ventricular apex.

Another introducer and sheath were inserted through guidewire into the subclavian vein. The introducer and the guidewire were removed, and atrial leads were placed through the sheath into the right atrial cavity. The leads were all secured and in acceptable ranges. A guiding catheter was introduced into the subclavian vein. The coronary sinus was cannulated with the guide catheter via the coronary sinus ostium. A guidewire was passed, under fluoroscopic guidance, through the catheter and into the coronary vein and the left ventricular lead was placed and tested. The pocket was reinspected for any active bleeding. The device was placed in the preformed pocket, and the three leads were attached.

Testing of the lead and device was performed and all parameters were in an acceptable range. The surgical wound was irrigated. The deep fascia was closed with interrupted 2-0 Vicryl followed by running sutures, and a sterile dressing was applied to the surgical wound. The patient tolerated the procedure well and left the room in good condition.

Assign the correct ICD-9-CM, CPT, and/or HCPCS code(s) for the facility.

Left heart failure

33240 Insertion of single or dual chamber pacing cardioverter-defibrillator pulse generator

33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system) (List separately in addition to code for primary procedure)

HCPCS Device

C1721 Cardioverter-defibrillator, dual chamber (implantable)
C1900 Lead, left ventricular coronary venous system

CPT code 33240 describes the insertion of the dual chamber pacemaker. An additional lead is placed into the left ventricle. CPT code 33225 is used to report the additional lead placement. Both procedures require the appropriate device codes.

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