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Day 2 of AAPC’s hybrid regional HEALTHCON in Denver, Colo., Aug. 3-5, got off to a great start with a discussion on how to create a work/life balance — something that many people struggle with possibly even more since being resigned to work from home because of the public health emergency. The irony was not […]
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AAPC’s posse pulls off a hootin’ good time for all! AAPC HEALTHCON 2021 attendees finished up day four of conference, heads whirling with essential information they will take back to their workplaces; hearts full after connecting with their peers; and bodies destressed after an inspiring talk from motivational speaker Denise Ryan. Whether remote or in […]
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Coding initial hospital care became more challenging after Medicare stopped paying for inpatient consult codes several years ago — but that can’t be the only factor driving the startling error rates for evaluation and management (E/M) codes 99223 and 99214. In the report “2019 Medicare Fee-for-Service Supplemental Improper Payment Data,” the Centers for Medicare & […]
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An incision was made and the right sided generator pocket was created, bleeding was sought and appropriate areas were cauterized. We used a tunneling tool and brought the RV ICD lead from the right pocket into the left. The LV lead was freed up in the right sided pocket and had enough length to reach RA and LV leads were tunneled over the left sided pocket and connected to the device.
The device was placed in Tyrx pouch and placed in the left sided pocket and a single layer Vicryl 2-0 sutures were placed in the SQ plane and DFT testing was performed in multiple configurations. The DFT testing was unsuccessful requiring external rescue multiple times. The RV lead was repositioned in the apex and DFT were tested again in multiple configurations and was unsuccessful.
We then proceeded with the left subclavian venous access using a micropuncture needle and seldinger technique and a 9 Fr sheath was placed. Using a JR4 and KA-2 diagnostic catheters along with Wooley wire and Glide wire, injection of contrast dye, we were able to cannulate the Azygos vein, however were unable to advanced the wire further and could not successfully access the vein.
We then re-prepped the patient and positioned her in the right lateral position. We made an incision in the left anterior axillary line after infiltration of 1% Lidocaine. The incision was extended down the fascia and tunneling tool was used to tunnel to the posterior paraspinal region. A SQ coil was then placed using a peel away sheath and the peel away sheath was slit and removed. The coil was then tied down to the fascia using 0-Ticron. We then tunneled the SQ coil back into the ICD pocket and connected it to the high voltage splitter adapter. The lead adapter was then connected to the device and the device was placed in a Tyrx pouch. The pocket was flushed multiple times during the procedure using antibiotic solution. DFT testing was successful.
During pocket closure, there was a noise/clatter on the RV coil of the ICD lead. The pocket was opened again and the lead disconnected from high voltage adapter. Ticron sutures on RV lead were cut and removed. Using a straight stylet, the screw on the ICD lead was retracted and lead repositioned in the RV apex. The ICD lead was reconnected to the ICD using the adapter. Pocket was flushed again and device was placed in the Tyrx pouch and tied down using 0-Ticron. The pocket was closed and DFT testing was repeated and it was successful.
Thank you!
Impression and Plan Summary:
Abnormal finding on a mammogram.
Orders: Mammo: screening bilateral mammogram.
DIABETES MELLITUS – TYPE II- WITH RENAL COMPLICATIONS. reviewed labs and made a copy for patient
CKD STAGE 3 (GFR 30-59) advised to drink more water, recheck labs in a month
orders: basic metabolic panel, microalbumin.
Additionally, iron deficieny, overweight (bmi 25-29.9), diabetes mellitus-type II- with neurological complications, hypertension with ckd, depression, gerd, and hyperlipidemia mixed have all been reviewed and are stable.
– Due to the renal complications and CKD would you say that it is appropriate to consider this a high level of risk under the presenting problems column.
TIA
KM
An ultrasound was done and the patient has a 5 cm mass near her ovary. The MD is planning surgery to remove the mass, it is not known for certain whether or not the mass is benign or malignant. The MD believes that the mass is an identified risk factor because the mass is potentially cancerous. We believe that at this point, the surgery should not be given credit for high risk surgery with identified risk factors because the mass is not identified as being cancerous at this point.
I could consider this being a risk factor if the provider makes the case for it in the note, but just a mass with the potential of being malignant we do not believe to be an inherent identified risk factor.
Thoughts???? Thank you!
Thank you.
Karen Palmer