Problem
The following documentation is from the health record of a 67-year-old male.
Procedure: Placement of a dual chamber implantable pacing cardioverter-defibrillator
Indications: Patient has moderate ischemic cardiomyopathy, prior, infarct and stent
Description of the Procedure: After informed consent was obtained, the patient was brought to the cardiac lab. Teh procedure was done under conscious sedation with fluoroscopic guidance. 1 percent Lidocaine was used to anesthetize the skin under the left clavicle, and a skin incision was made. A pocket was made for the ICD generator and leads, securing good hemostasis. The left subclavian vein was easily cannulated twice using a pediatric set. which was upsized to regular 037 wires, the position of which was checked under fluoro.
I then dilated the access volts with 9-French dilators and used 7-French access sheaths through which a 7-French ventricular lead was advanced and placed under fluoroscopic guidance. It was an active fixation lead. The numbers looked good, and the lead was sutured down. There was no diaphragmatic stimulation.
A 7-French lead was then advanced under fluoroscopic guidance and placed in the right atrial appendage. The numbers looked good. There was no diaphragmatic stimulation, and the lead was sutured down. The leads were then attached to the generator which was tested and sutured down in the pocket. The wound was irrigated several times with antibiotics during and at the end of the case. Wound was closed in layers. The patient tolerated the procedure well without any complications.
The ICD is Model Virtuoso DRD 154AWG. Atrial and ventricular leads are Medtronic, Battery voltage is 3.17volts. Sensed P waves of 2.5 millivolts through the PSA slew rate of 0.6 volts per second impedance of 539 ohms, threshold of 17 volts at 0.5 milliseconds current of 3.9 milliamperes, sensed R waves of 21 millivolts, slew rate of greater than 4 volts per second, impedance of 965 ohms, threshold of 0.8 volts at 0.5 milliseconds, and current of 0.8 milliamperes.
Through the device, sensed P waves of 2.3 millivolts, impedance of 472 ohms, threshold of 1 volt at 0.5 milliseconds, sensed R waves of 12.1 millivolts, impedance of 752 ohms, threshold of 1 volt at 0.1 milliseconds, HVB impedance of 38 ohms, HVA impedance of 44 ohms.
Defibrillator threshold testing was done. Battery was B2AX, rhythm induced was ventricular fibrillation with T shock, impedance of 43 ohms, energy delivered was 20 joules, charge time was 3.8 seconds, sensitivity was 1.2 and it was successful.
Tachy parameters are VF zone of 300 milliseconds at 200 beats. Therapies are 30 joules and then 35 times 5 with 80 P during charging for VT. Monitor zone is between 150 and 200 beats per minute. Brady parameters are AAI with backup DDD. Managed ventricular pacing at 50 to 120. PAV of 180, SAV of 150. Mode switch at 171.
Impression: Successful dual chamber ICD implantation as noted above. EPS testing of leads and generator. The patient will be monitored in observation, will get further doses of antibiotics, and be sent home when stable.
What CPT code(s) describe(s) this cardiac lab service?