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Subcutaneous coil array addition to existing Bi-V ICD with DFT testing

Date: Jul 29, 2022

Question:

I need your opinion on this case. I'm thinking 33216 for subcutaneous coil implant, 93642 for DFT testing, and 33215 for RA lead reposition. Note: patient had inpatient status and presented with existing multi-lead ICD.

"Indications: Unsuccessful shock for VT, RA lead dislodged. Procedure description: Add subcutaneous ICD coil, repo RA lead, ICD lead/generator testing (existing generator). Using tunneling tool, sheath was advanced posteriorly with fluoroscopy for coil placement. Lead was secured and incision made over previous ICD incision to capsule around generator, which was explanted. RA lead was disconnected and then repositioned in RA and fixation deployed with excellent sense/pace thresholds. RV coil (HVB) plug was removed, and subcutaneous coil was connected to its port. RA lead was secured. Tunnel was created from subpectoral pocket to anterior axillary pocket, and lead was pulled into pocket, then connected to ICD generator. Device testing was performed. Ventricular fibrillation was induced through device which detected VF and terminated it with single 20 joule biphasic shock."

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