Question 20 4 out of 4 points preoperative diagnosis

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Question 20 4 out of 4 points PREOPERATIVE DIAGNOSIS: Heart Block POSTOPERATIVE DIAGNOSIS: Heart Block ANESTHESIA: Local anesthesia NAME OF PROCEDURE: Reimplantation of dual chamber pacemaker DESCRIPTION: The chest was prepped with Betadine and draped in the usual sterile fashion. Local anesthesia was obtained by infiltration of 1% Xylocaine. A subfascial incision was made about 2.5 cm below the clavicle, and the old pulse generator was removed. Using the Seldinger technique, the subclavian vein was cannulated and through this, the old atrial lead was removed, and a new atrial lead (serial # 6662458) was placed in the right atrium and to the atrial septum. Thresholds were obtained as follows: The P- wave was 1.4 millivolts, atrial threshold was 1.6 millivolts with a resultant current of 3.5 mA and resistance of 467 ohms. Using a second subclavian stick in the Seldinger technique, the old ventricular lead was removed and a new ventricular lead (serial # 52236984) was inserted and placed into the right ventricular apex. The thresholds were obtained and were as follows: R-wave was 23.5 millivolts. The patient was pacing at 100% at 0.5 volts, with resultant current of 0.8 mA and resistance of 480 ohms. When we were satisfied with the thresholds, the leads were connected to the pacemaker generator (serial # 22561587), which was inserted into the previously created pocket. The wound was thoroughly irrigated with antibiotic solution and hemostasis was obtained. The incision was closed in layered fashion with 2-0 Dexon. A compressive dressing was applied, and the patient tolerated the procedure very well. He was taken to the recovery room in satisfactory condition. Selected Answer: a. 33235, 33208-51, 33233-51 Correct Answer: a. 33235, 33208-51, 33233-51 Response Feedback : Rationale: Code 33235 reports removal of the electrodes of a dual pacemaker
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lead system. Code 33208 reports replacement of permanent pacemaker generator with transvenous electrodes to the right atrium and right ventricle, and 33233 reports the removal of a pacemaker generator. Modifier 51 reports multiple procedures performed during the same session. Look in the CPT® Index for Pacemaker, Heart/Insertion which direct you to 33206-33208. Next look for Pacemaker, Heart/Removal/Pulse Generator Only which directs you to 33233. Look for Pacemaker, Heart /Removal/Transvenous Electrodes which directs the coder to 33234-33235. Question 21 4 out of 4 points A patient is brought to the operating suite when she experiences a large output of blood in her chest tubes post CABG. The physician performing the original CABG yesterday is concerned about the post-operative bleeding. He explores the chest and finds a leaking anastomosis site and he resutured. Selected Answer: b. 35820-78 Correct Answer: b. 35820-78 Response Feedback : Rationale: This is a postoperative exploration and modifier 78 is necessary because this is an unplanned return to the OR by the same physician during the global period of another procedure. Modifier 78 is used for a return to the OR for complications. This was an exploration for postoperative hemorrhage of the chest.
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