![]() ![]() When the patient is in chronic atrial fibrillation and the ventricle rhythm is quite irregular, only a single lead is placed in the ventricle (because the fibrillating atrium cannot be paced).ģ. When the only problem is with the formation of the initial impulse in the atrium, simply placing a lead in the right atrium will “start things off” when it’s needed, and the electrical impulse will then continue normally through the rest of the atrium, the AV node and the ventricles.Ģ. Single lead pacemakers are used primarily in four situations:ġ. Sometimes it is simply caused by “aging” of the conduction system. The underlying cause of this may be scar tissue, most frequently from previous heart attacks. Most often, this occurs because there is no cell in the heart that will beat fast enough to maintain proper function, or because there is a “block” somewhere in the electrical pathway that doesn’t allow the electrical activity to spread to all of the necessary portions of the heart muscle. Most pacemakers are placed to prevent the heart from going too slow. Patients require pacemakers for many different reasons. Newer types of pacemakers can correct some types of rapid heart rhythms as well. Pacemakers have become a reliable means of helping people live longer and improve their lifestyles despite having a slow heart rhythm. Those that speed the heart rate are poorly tolerated and very often associated with serious side effects. ![]() Pacemakers are necessary because, while there are many medications that prevent the heart from going too fast, there are only a handful that make it go faster. Their main purpose is to keep the electrical system from going too slow and thereby prevent the problems associated with slow heart rhythms (passing out, congestive heart failure and others, including death). The former may be done on an outpatient basis, but the later is an inpatient procedure.įor a list of the available codes and their descriptions, visit the online version of this article at Today’s pacemakers can be programmed in literally millions of possible combinations. For the purpose of this article, we will address only those procedures in which the electrodes are inserted through the vein, transvenous, and not those where the electrodes are placed on the surface of the heart, epicardial. There is also the possibility of the requirement of another electrode being placed in the left ventricle for the purpose of biventricular pacing. Also, one must keep in mind the type of pacemaker, single or dual chamber with the corresponding placement of the leads, atrial and/or ventricular. There are initial insertions, replacements of all the components, replacements of some of the components, repositioning, repair, upgrades, etc. ![]() The CPT coding of permanent pacemakers with transvenous electrodes present a challenge to the coding community simply because of the many procedures involved. The second part of this article, discussing more details about integumentary coding, will appear in the August 16 issue.) (Editor’s note: The previous column, “Brush Up on Integumentary System CPT Coding, Part 1” ran in the June 21 issue. Permanent Pacemakers with Transvenous Electrodes Present CPT Coding Challenges ![]()
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