Question: Code the following case study. One code is required. Preoperative Diagnosis: Symptomatic third-degree heart block Postoperative Diagnosis: Symptomatic third-degree heart block Procedure: Placement of permanent
Code the following case study. One code is required. Preoperative Diagnosis: Symptomatic third-degree heart block Postoperative Diagnosis: Symptomatic third-degree heart block Procedure: Placement of permanent pacemaker with transvenous electrode, ventricle Anesthesia: Local infiltration of lidocaine 1%, total volume 13cc Complications: None Indications: This 74-year-old man was admitted with a diagnosis of three-degree heart block complicated by congestive cardiac failure. Patient is schedule for placement of a permanent pacemaker today. Procedure Notes: With the patient supine on the operating table with a shoulder roll placed beneath the thoracic spine, the chest was prepared and draped in a sterile fashion. In the right infraclavicular region, a subcutaneous pocket was created for containing the pulse generator. Using an introducer guide wire, a sheath technique bipolar-targeted lead was introduced into the right subclavian vein. Under fluoroscopy control, this was directed into the right ventricle. Two initial locations were not satisfactory for pacing parameters. Finally, the pacemaker was positioned in satisfactory position with the following parameters: at the threshold 0.4 volts, current 1.5 milliamps, and R wave 15. The pacing system analyzer was then turned to 10 volts output and the diaphragm observed for pulsations, which were not proven. The lead was then secured under the clavicle with a single suture of 2-0 Ethibond. It was then attached to a 5794 Medt
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