Ask Dr. Z

I need some help coding the following. The patient was brought to the heart catherization laboratory and draped in the usual sterile fashion. Consent was obtained prior to the procedure. IV conscious sedation as given using Versed and fentanyl thoughout the case. Next we attempted to cannuulate the left subclavian vein.We then took a venogram of the left subclavian vein and it was found to have diffuse collaterals and no good discrete subclavian vein to proceed with the implant on that side. Therefore, we went to the right side of the patient and we took a venogram and this time there were good images seen of the right subclavian vein. Next approximately 15Ml of lidocaine were used to anesthetize the planned pacemaker pocket on the right side of the patient.Next using Seldinger techinique two subclavian access sites were obtained and then the pacemaker pocket was created using a scapel and cautery. At this point over a 7-French introducer sheath the right ventricular lead was positioned into place near the lower RV septum. This sheath was torn and peeled away and another 7-French introducer sheath was inserted and the lead was then placed at the right atrial appendage. RV pacing leads were kept on the patient due to the fact that he had a baseline left bundle branch block. Next the coronary sinus sheath was inserted and a specific sheath for the right-sided coronary sinus was inserted and using a J-tipped guidewire we able and contrast we were successfully able to cannulate the coronary sinus. Tehre was found to be a mild lateral vein though small which was used as our planned placement for the LV lead. At this point the LV was positioned over a coronary guidewire into the mid lateral vein and successfully wedged into that position. The sheath was then slit appropriately and the lead was kept in place. At this point pacing thresholds were also checked here and they were within normal limits. Next the sheath was torn and peeled away and all 3 leads were sutured using 0 silk to the left pectoral muscle. Next antibiotic solution with consisting of Bacitracin and gentamicin was used to flush the pocket at this point. At this point 2-0 and 4-0 Vicryl sutures were used to close the pocket. Steri-strips were applied on the skin level. The estimated fluoro time would be 25 minutes. Implanted Device: Boston Scientific Guidant Contact Renewal CRT pacemaker. the patient had a heart cath with grafts: 93459-26 ICD Insertion: 33249 33225 71090-26 Is this correct codes to use?