Question

ICD 10 PCS Code Please

1. Operative Report

This is an 86-year-oid lady with left bundle, intermittent complete heart block, first-degree AV block and syncope. For the above reasons, she is undergoing implantation of a permanent pacemaker.

PROCEDURE: The patient was brought to the EP laboratory in a fasting state. Her left chest was prepped and draped in the usual sterile fashion. After local anesthesia, an incision was made on the left deltopectoral groove. The cephalic vein was isolated. The distal end was tied off. A venotomy was made and a Medtronic model 5076-52 lead was placed percutaneously into the right ventricular apex. In its final position, it was sutured in place with 2-0 Ethibond sutures. Final thresholds were for R waves of 18. Pacing threshold of 0.5 msec and lead impedance of 95

An 18-gauge needle was easily placed into the left subclavian vein. Through that needle, a wire was advanced under fluoroscopic guidance into the IVC. Over this wire, a 7-French sheath was advanced and through this sheath, a Medtronic model 5076-52 lead was placed percutaneously in the high right atrium. In its final position, it was sutured in place with 2-0 Ethibond sutures. Final thresholds were for P waves of 18, Pacing threshold of 2 V and pacing impedance was 586.

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

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

IMPRESSION: Successful implantation of Medtronic dual-chamber pacemaker.

2. Operative Report

PREOPERATIVE DIAGNOSIS:       Infected Broviac central venous catheter POSTOPERATIVE DIAGNOSIS:     Infected Broviac central venous catheter PROCEDURE PERFORMED:          Removal of infected central venous catheter ANESTHESIA:                                      General

PROCEDURE: The child was brought to the operating room, and general anesthesia induced. A double-lumen Broviac catheter was identified exiting through an anterior chest wall incision. Local anesthetic was infiltrated at the exit site, and the subcutaneous tissue attached to the catheter was spread and percutaneously divided sharply until the central venous catheter was free and removed from the superior vena cava, and the tunneled catheter was removed from the subcutaneous layer of the chest. Pressure was used for hemostasis, and a ster­ile dressing applied to the exit site. Sponge, needle, and instrument counts were reported to be correct at the conclusion of the procedure. The child was awakened and taken to the recovery room in satisfactory condition.

Cases (Code appropriately)

1.  There was an open insertion of the dual chamber pacemaker in the subcutaneous pocket of the chest. The cardiac leads were inserted in the right atrium and right

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

ICD 10 PCS Code Please

Answer 1

The   ICD-10 procedural coding system abbreviated as ICD-10-PCS , is an international system utilized by health care organizations to code specific procedures, including operative, medical, or diagnostic services.

Question No	ICD-10-PCS code	Name of intervention
1	0JH606Z	This code is used to denote insertion of a pacemaker ( dual chamber) into subcutaneous tssue and fascia of chest by open technique.
2	0JPT0XZ*	This code represents removal of tunneled vascular access device from trunk subcutaneous tissue (in this case,chest) and fascia by open approach
02PY33Z*	It indicates removal of infusion portion of central venous catheter from a great vessel (in this case ,superior vena cava) through  percutaneous approach

*A tunneled central venous catheter has two parts-

· an infusion port also called as infusion device or infusion portion and

· catheter ( the vascular access device)

While coding removal of this device , write codes for both the infusion port and catheter removal.