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rCardiac resycronization, two leads in RV instead of 1 in RV and 1 in LV

Date: Nov 20, 2019

Question:

A patient diagnosed with dilated cardiomyopathy (LVEF 45%), chronic atrial fibrillation with rapid ventricular rate paroxysmal AV block with 3 second pauses, and tachy-brady syndrome came in for a cardiac resynchronization therapy pacemaker implant, coronary sinus venography, cinefluoroscopy, and AV node ablation. My question is in regards to the pacemaker insertion. How would you code the below scenario: 33208, 33207, unlisted, or other? "An electrode was advanced to the right ventricular septum… The electrode was anchored to the underlying fascia with a single stitch of 0 silk over the collar. A 9.5 French peel-away sheath was placed in the central venous circulation utilizing the retained guide wire in the vein. The coronary sinus ostium was found to be occluded. A small middle cardiac venous branch was not able to be cannulated either. The patient was not a candidate for an epicardial LV lead, and it was opted to pursue cardiac resynchronization with two RV leads. The first lead was placed on the RV septum, and the second lead on the RV apex."

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