ICD 10 PCS Code Please

1. Operative Report

This is an 86-year-oid lady with left bundle, intermittentcomplete heart block, first-degree AV block and syncope. For theabove reasons, she is undergoing implantation of a permanentpacemaker.

PROCEDURE: The patient was brought to the EPlaboratory in a fasting state. Her left chest was prepped anddraped in the usual sterile fashion. After local anesthesia, anincision was made on the left deltopectoral groove. The cephalicvein was isolated. The distal end was tied off. A venotomy was madeand a Medtronic model 5076-52 lead was placed percutaneously intothe right ventricular apex. In its final position, it was suturedin place with 2-0 Ethibond sutures. Final thresholds were for Rwaves of 18. Pacing threshold of 0.5 msec and lead impedance of95

An 18-gauge needle was easily placed into the left subclavianvein. Through that needle, a wire was advanced under fluoroscopicguidance into the IVC. Over this wire, a 7-French sheath wasadvanced and through this sheath, a Medtronic model 5076-52 leadwas placed percutaneously in the high right atrium. In its finalposition, it was sutured in place with 2-0 Ethibond sutures. Finalthresholds were for P waves of 18, Pacing threshold of 2 V andpacing impedance was 586.

Pacing was done at lOV and there was no diaphragmaticstimulation from either lead. Pacing threshold with deep breathingand coughing failed to result in loss of capture.

A pocket was made inferomedial to the incision. This was in theprepectoral space. The pocket was exam­ined for bleeding and clotsand none were evident. It was irrigated with antibiotic solutions.The leads were attached to a Medtronic model VEDR01. This wasplaced in the pocket with excess lead posterior to it and wassutured into place. The pocket was closed with interrupted 2-0Vicryl, reinforced with running 3-0 Vicryl. The skin was closedwith subcuticular 4-0 Dexon, and reinforced with Steri-strips. Thepatient tolerated the procedure well and was transferred back toher room in stable condition.

IMPRESSION: Successful implantation ofMedtronic dual-chamber pacemaker.

2. Operative Report

PREOPERATIVEDIAGNOSIS: InfectedBroviac central venous catheter POSTOPERATIVEDIAGNOSIS: Infected Broviaccentral venous catheter PROCEDUREPERFORMED: Removalof infected central venous catheterANESTHESIA: General

PROCEDURE: The child was brought to theoperating room, and general anesthesia induced. A double-lumenBroviac catheter was identified exiting through an anterior chestwall incision. Local anesthetic was infiltrated at the exit site,and the subcutaneous tissue attached to the catheter was spread andpercutaneously divided sharply until the central venous catheterwas free and removed from the superior vena cava, and the tunneledcatheter was removed from the subcutaneous layer of the chest.Pressure was used for hemostasis, and a ster­ile dressing appliedto the exit site. Sponge, needle, and instrument counts werereported to be correct at the conclusion of the procedure. Thechild was awakened and taken to the recovery room in satisfactorycondition.

Cases (Code appropriately)

1. There was an open insertion of the dual chamberpacemaker in the subcutaneous pocket of the chest. The cardiacleads were inserted in the right atrium and right

2. Removal of Device from the subcutaneous tissue ofthe chest and removal of the infusion device from the superior venacava, a great vessel. Broviac catheter is a type of vascular accessdevice. This was inserted into the superior vena cava to allow longterm vascular access without repeated re-puncture of the vein, withthe infusion catheter placed in the superior vena cava. Thevascular access device was removed from the subcutaneous tissue ofthe chest and the infusion catheter from the superior vena cava,both using a percutaneous approach.

ICD 10 PCS Code Please