Coding And Reimbursement

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Analysis of Coding and Reimbursement Schedules and Methods

Analysis of Coding and Reimbursement Schedules and Methods

Case Description

The patient is a 69-year-old woman with defibrillation-related cardiac arrest. She has an extensive history of heart disease as well as prior cardiovascular surgery, and pacemaker placement in 1997. A cath, which was performed earlier, revealed normal coronaries. The cardiologist then tested the existing pacemaker and found it was not performing adequately. The skin was also starting to show erosion. Based on these findings, the cardiologist decides to place an implantable cardioverter defibrillator (ICD).


We have condensed the following report from the cardiac catherization lab to describe the procedure relating to coding and reimbursement.

Because the patient had very little subcutaneous tissue or muscle tissue in the pectoral regions, the cardiologist elected to place the system in the abdomen.

Using Xylocaine 1% local anesthesia, a left delta pectoral incision was made and cephalic vein cutdown made. The Medtronic ICD lead Model 6945 (100 cm) was introduced. The lead was then secured to the underlying subcutaneous tissue and a loop made in the delta pectoral region. Another sleeve was anchored. The lead was then tunneled down to the abdomen where an incision was made and using blunt dissection, a pocket was fashioned and irrigated with antibiotic solution. A Medtronic Gem 7227CX ICD was connected and then placed in the abdominal pocket and anchored to the underlying subcutaneous tissues. The subcutaneous tissue and subcuticular tissue was closed. Prior to closure of the skin sutures, V-fib induction was performed. The first episode of ventricular fibrillation failed at 8 joules, but at 14 joules was successful in converting the rhythm to sinus (Newby 2004).

A second episode of ventricular fibrillation was created and terminated promptly to sinus rhythm with a 14 joules shock.

Attention was geared to removal of the ...
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