Ask Dr. Z

We are requesting your opinion on an accurate comparable code. We suggested code 33215; however, the provider prefers 33300 (at 10% work effort) due to prepping in case things didn’t go as planned. "Operative Note: Patient had a temporary lead perforate the RV. A permanent system was placed before the patient was transferred here. The patient was taken to the OR and placed under general anesthesia. I was prepared to perform placement of a percutaneous drain, moving to a subxiphoid pericardial window, moving to a full sternotomy to repair the defect directly if complications occurred. We began with exam of the heart under fluoro, then, with a good eye on the lead, we carefully pulled it back through the perforated site, into the heart, then into the SVC. Echo confirmed there was no effusion or evidence of bleeding, indicating that allowing the pericardial space to seal functioned successfully and there's no need to open the patient. I removed the lead back into the sheath, and the procedure was concluded. The lead was successfully removed without complications from the perforated RV."