Question

SURGEON: Marvin Elhart, M.D.

PREOPERATIVE DIAGNOSES: Bradycardia.

PROCEDURE PERFORMED: Dual-chamber pacemaker implantation

BRIEF HISTORY: This patient has been experiencing recurrent syncope. He was evaluated in the last year or so. Because of

the presence of first-degree AV block, sinus bradycardia, and bundle-branch block, the cause for his syncope most likely is

his bradyarrhythmia; for that reason, a dual-chamber pacemaker implantation was recommended after discussion with his

cousin, who consented to the procedure. The cousin was informed of all potential complications, including infection,

hematoma, pneumothorax, hemothorax, myocardial infarction, and even death. He agreed to proceed

PROCEDURE: The patient was brought to the cardiac catheterization laboratory. He was placed on the catheterization table,

where he was prepped and draped in the usual fashion. The procedure was extremely difficult to perform as a result of the

patient’s agitation despite adequate sedation. With reasonable hemostasis, the pacemaker pocket was performed in the left

infraclavicular area after anesthetizing the area with 0.5 cc of Xylocaine. Hemostasis was secured with cautery. The patient

had excessive venous oozing from Valsalva and straining, and that was controlled with pressure. A single stick was

performed because of the patient’s agitation. Using a 9-French peel-away sheath, we introduced an atrial and a ventricular

lead and placed them in an excellent position. Thresholds were obtained adequately. The leads were sutured using 0 silk

over their sleeves and secured. The pulse generator was connected. The pacemaker pocket was flushed with antibiotic

solution. The pacemaker and leads were placed in the pocket and the pocket closed in two layers. Procedure under

fluoroscopic guidance.

COMPLICATION: None

EQUIPMENT USED: Pulse generator was Medtronic model 60 Thera DRI, serial B28H. The ventricular lead was Medtronic

serial L420V, model 4524 Link. The atrial lead was Medtronic 24-58, serial 326V. The following parameters were obtained

after implantation: Pacing threshold in the atrium was excellent at 0.5 msec and 0.5 V, and impedance was 445 ohms and

sensing 2.1 mV. In the ventricle, 0.5 msec and 0.3 V with R wave of 19.9 mV and impedance 668. The following parameters

were left at implantation: DDDR with lower rate limit of 70 and an upper rate limit of 120. The amplitude was 3.5 V in the

atrium at 0.4 msec with a sensitivity of 0.5 mV. The ventricle was 3.5 V and 0.4 msec at 2.8-mV sensitivity.

CONCLUSION: Successful implantation of dual-chamber pacemaker without immediate complications.

PLAN: Patient to return to recovery unit and to be discharged late this evening to the nursing home with routine

postpacemaker care.

Need ICD 10, CPT

Answer 1

CPT code is current procedural terminology . It is used to code the procedures by the health care workers and is also used by insurance company people to represent a procedure for reimbursement purpose .

CPT code for dual chamber pacemaker implantation is 33217 . It is used for insertion of two transvenous electrodes permanent pacemaker .

ICD -10CM code is tenth version of international classification of diagnosis . It is used by physicians and other health worker to represent a diagnosis ,sign and symptoms . Also this is used by insurance company for reimbursement purpose.

ICD code for bradycardia is R00.1