Ask Dr. Z

I know that pocket revision verses relocation gets a lot of discussion. I have a physican who is giving a bit of push back about recommendation of repair codes. He states this is not a wound that is being repaired. Case summary. I would like to provide documentation that answers his direct question. 

"Ms. X is a 75-year-old female who reports that her pacemaker site is uncomfortable and impacts her quality of life and her sleep. Once the generator was removed from the pocket, I did not disconnect the right atrial, right ventricular, and left ventricular endocardial leads from this device. Instead, I performed dissection down to the pectoralis fascia and muscle more medially. There was adequate hemostasis, and antibiotic solution was utilized to irrigate the pocket. Device was placed back in the pocket, and a stitch with Ethibond was applied to keep the generator in place. It was moved more medial, deeper and more caudal. The pocket was then closed with 2-0 Vicryl, 3-0 Monocryl and Silverlon dressing. A TYRX pouch was placed."