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Thank you!
Michele
PROCEDURE PERFORMED:
Medtronic pacemaker generator change.
INDICATIONS:
Pacemaker generator at ERI.
The risks and benefits of pacemaker generator change was discussed with
the patient and her daughter. She is agreeable to the procedure. Consent
was obtained.
Time-out was performed. The patient, procedure, and physician were identified.
She received Versed 1 mg, fentanyl 50 mcg intermittently during the procedure
for conscious sedation.
The patient was prepped and draped in the normal fashion. 1% lidocaine
was infiltrated at the left lateral border of the old pacemaker generator.
A 3 to 4 cm linear incision was made. The patient’s skin was very
thin and the pacemaker generator was notably superficial. The pacemaker
leads were also notably visible under the very thin skin. Bovie cauterization
and blunt dissection were carried down to the pacer capsule. The pacer
capsule was notably heavily calcified with an eggshell case. The pacemaker
generator was externalized and a new pacer was attached to the atrial
and ventricular lead. Note, the atrial lead is a nonfunctional lead.
Rather than leaving a blunt and pacer lead that was capped under a
thin skin, it was decided to place the cap in a dual-chamber head in
an effort to reduce risk for site erosion from the lead tip. The heavily
encasement calcification was meticulously removed. Extensive dissection
and debridement of the calcific shell was performed. The atrial and
ventricular lead were mobilized. The leads were tacked down to reduce
the tension that was previously noted before the procedure in an effort
to reduce risk for lead erosion. The new pacer pocket was made a bit
more inferior than the previous pocket. The pacer was secured to the
pectoralis. The pacemaker pocket was generously irrigated with antibiotic
solution. The pacer pocket was closed with 2-0 Vicryl interrupted sutures
for the deep layers. Generous puckering of the skin was noted to reduce
the tension of the very thin superficial placement of the generator.
The subcuticular layer was closed with 4-0 Monocryl. The incision
was covered with benzoin and Steri-Strips.
The patient awoke from conscious sedation without apparent neurologic
deficit. She was transferred to the holding area in stable condition.
The pacemaker generator is a Medtronic Azure XT DR MRI, model #W1DR01,
serial #.
The atrial lead is model #4271 Boston Scientific, serial #, implanted
10/04/1993.
The right ventricular lead is a Boston Scientific model #4262, serial
#, again serial #. R-wave is 9.9, pacing impedance is
380 ohms, pacing threshold is 1.5 at 0.4 milliseconds. The atrial lead
is inactivated. The impedance was noted to be 114 ohms.
A patient who has been on our hospice service came in with this code as their primary dx in April. Claims through Kaiser have always been accepted. When trying to get their October claim filed, however, it was suddenly kicked back to us as an unacceptable primary code.
I have not found anything that would support it’s sudden exemption as it is an HCC and rare so it would not make logical sense that it was suddenly removed from the acceptable list.
Any help would be most appreciated!
Lynn McDougal, CRC
Remember back in 2015 when CPT® changed the definition of an incomplete colonoscopy from one that does not evaluate the colon past the splenic flexure to one that does not evaluate the entire colon? The Centers for Medicare & Medicaid Services (CMS) is responding to that change, albeit rather lethargically. CPT® 2015 stated (and continues to […]
The post Rates Change for Incomplete Colonoscopies in Critical Access Hospitals appeared first on AAPC Knowledge Center.
The ICD-10-CM Official Guidelines for Coding and Reporting is effective Oct. 1 through Sept. 30. That means the updated guidelines for fiscal year 2019 have been in effect for a month, already, by the time this issue makes it to your mailbox (or inbox). Changes include a new coding guideline in the Coding Guidelines section; […]
The post 2019 ICD-10-CM Guideline Updates Call for Change appeared first on AAPC Knowledge Center.
Notes: Pt in today for tracheostomy tube change , present trach was checked after 8 cc air, cuff did not hold any inflation. Pt did bring a Shiley Cuffed tracheostomy Tube 4DCT.5.0mm I.D. 9.4mmO.D. Current trach was checked noting a cuffed 4DCT with same dimensions. Pt was reclined back in her chair, cuff was checked again for complete deflation. Pt was suctioned obtaining only minimal secretions. Inner cannula was removed and was clear. Trach was removed with minimal effort, oxygen delivered. Pt rested for aproximately 45 sec. then new trach was inserted with minimal resistance. Pt tolerated procedure very well. 5 cc of air was introduced into cuff. Inflation noted. Air was then removed and speaking valve was placed.
Thank you in advance,
Kimberly Lynn, CPC
The alternative is long-term financial loss and patient dissatisfaction. Change is hard, but failing to change imposes a high cost. It costs more to stay broken than to make changes you need. This article teaches you a three-step approach to make difficult but necessary changes in your healthcare practice or facility. Change Is Necessary for […]
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One of the fiercest fights in surgery is about ears. Do you cover them while conducting surgery? This simple question has fueled a bitter fight ever since The Association of periOperative Registered Nurses (AORN) officially recommended that bouffant hats be worn in the OR by all surgical team members. Since then, there’s been a back-and-forth of testy statements and unsatisfying studies.
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By now, many of you have read or at least heard about the proposed changes to E/M service reporting included in the CMS proposed rule relating to the 2019 Medicare Physician Fee Schedule. This proposal was published in the July 27, 2018 Federal Register. Because there are only sixty (60) days to submit comments, the […]
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