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1. AV node ablation , Left bundle-branch pacing

Date: Jan 24, 2023


.Using fluoroscopic guidance via 9 French sheath a left bundle branch guide sheath and lead were placed into the left bundle branch position. Prior to placing the lead the his bundle was identified in order to guide positioning. Using electrocardiogram and fluoroscopic guidance the appropriate position was found and the lead was screwed into position. Once the appropriate numbers verified left bundle branch specific pacing the sheath was removed and the lead was fixated to the muscular fascia. Using fluoroscopic guidance via a 9 French sheath a Tacticath SE ablation catheter was advanced into the right atrium. A 3D electro anatomical map was created of the right atrium and the right ventricle noting the atrial signal, ventricular signal, his signal and the coronary sinus. An appropriate his signal was identified this was ablated. The doctor is wanting to bill 93619, 33208, is that proper billing? Shouldn't the 5 catheters be mentioned. I'm very confused about the LBB pacing implant. Does the 22 modifier up RVUs? HELP!!!

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