What is the code for a tunneled centrally inserted central venous catheter, without pump or port, in a 72-year-old patient?
Placement of a dual-chamber pacemaker. Using a standard technique, the left infraclavicular subcutaneous pacemaker pocket was created with sharp and blunt dissection. The 2 j-tipped guidewires were advanced through a left subclavian vein using standard left subclavian venotomy under fluoroscopic guidance. The peel-away sheaths and introducers were advanced over the guidewires, and the guidewires were removed. The pacemaker leads were advanced under fluoroscopic and electrophysiologic guidance into the right ventricular apex and right atrial appendage. The pacemaker leads were seen to function adequately in vivo and were sutured in place with 0 silk. The leads were connected to the pulse generator, which was delivered into the wound in the usual fashion; 2-0 Vicryl suture was used to close the deep tissue layer and a 4-0 running subcuticular suture was used to close the skin. There were no complications of the procedure.
PREOPERATIVE DIAGNOSIS: Right hemothorax
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Placement of anterior chest tube
PROCEDURE: The patient was draped and prepped in the usual manner. The area was infiltrated with 1% lidocaine. A 1-cm incision was made in the second intercostal space about 7 cm to the right of the midline in the anterior chest and a 20-F chest tube was passed. Good tidal volume was confirmed. The chest tube was anchored using 1-0 silk. The area was dressed and the chest tube placed on suction. The patient tolerated the procedure well. Complications—none.
A five-vessel coronary artery bypass using two arteries and three vein grafts. (Separate the codes with a comma in your response as follows: XXXXX, XXXXX.)
Abdominal aortogram. The right groin was prepped and draped in the usual fashion. Seldinger technique was used to enter the femoral artery. A 6-French sheath was placed. A pigtail catheter was introduced in the upper abdominal aorta, and an AP aortogram was done using the DSA cut film technique using 20 cc of Omnipaque.
Use HCPCS Level II modifier w/ CPT code... PTCA of left anterior descending coronary artery. A 6-French JL4 guiding catheter was used, and a 014 extra-support wire was passed through the LAD obstruction and "entered" the distal vessel. This was first dilated with a 3-mm 20 CrossSail balloon, subsequently with a 3.5 10 cutting balloon (arteriectasis). With the cutting balloon, there were four inflations at 6-7 atmospheres and up to 1-minute inflation times. The balloon was withdrawn, and angiography showed the vessel to be wide open with mild irregularities and less than 15% narrowing remaining. There was no distal embolism. There was no dissection noted. There was normal TIMI flow. The case was then terminated at this point and balloons, catheters, and wires were removed, and the patient was sent to her room in good condition.
Diagnostic thoracoscopy of the pericardial sac, with biopsy caused by chronic rheumatic pericarditis?