Operative Report Preoperative Diagnoses: Atrial fibrillation with

Operative Report Preoperative Diagnoses: Atrial fibrillation with sick sinus syndrome Postoperative Diagnoses: Atrial fibrillation with sick sinus syndrome Procedure: Insertion of Medtronics N rhythm dual chamber pulse generator pacemaker, model number P1501DR with atrial and ventricular leads under fluoroscopic guidance Anesthesia: 1 percent Xylocaine local with sedation Estimated Blood Loss: Minimal Comment: This is an elderly gentleman with atrial fibrillation and sick sinus syndrome who had a dual chamber pacemaker placed with a screw-in atrial lead in the operating room. During the time of implantation, the permanent lead parameters were recorded in the patient’s permanent health record and the entire procedure was performed under fluoroscopy. The patient has been on Coumadin for several years but blood loss was minimal. The patient tolerated the procedure well. Procedure: The patient was taken to the operating room and placed on the table in supine position. After adequate intravenous sedation was given, the left chest wall was prepped with DuraPrep and draped with sterile drapes in the usual fashion. After infiltration with 1 percent Xylocaine, an oblique incision was fashioned inferomedial to the deltopectoral groove. The incision was deepened to the skin and subcutaneous tissue to the pectoralis fascia where a pocket was fashioned inferiorly for the pulse generator. Through the wound, two Seldinger wires were placed uneventfully into the left subclavian vein with the patient in Trendelenburg and these were then exchanged for dilator and breakaway sheaths through which were introduced a tinned-tipped ventricular lead advanced to the central circulation under fluoroscopic guidance with the tip brought to rest in the apex of the right ventricle until satisfactory parameters were obtained in this location and the lead was then secured to the chest wall with three interrupted #2-0 Ethibond sutures. More medially, the dilator and breakaway sheath in this position was then replaced with a screw-in type pre-formed, J-shaped atrial lead advanced in the septal circulation under fluoroscopic guidance with the tip implanted in the right atrium with the screw-in device until satisfactory parameters were obtained in this location. This lead was secured to the chest wall in a similar fashion. The two leads then firmly connected to the pre-programmed Medtronics pulse generator model as noted above, which was placed into the previously fashioned subcutaneous pocket with the leads coiled beneath it. The subcutaneous tissues were irrigated with Ancef saline and the superficial subcutaneous tissues were closed over the top of the pacemaker leads with interrupted #3-0 Polysorb suture and the skin closed with running inverted, interrupted subcuticular #4-0 Biosyn followed by application of a Bioclusive dressing. Sponge, needle, and instrument counts were reported to be correct × 2 at the termination of the procedure. The patient tolerated the procedure well and left the Operating Room in satisfactory condition. What are the correct codes for this outpatient surgery? a. I49.01, I49.5, 33202, 33213 b. I49.01, I49.5, 33212, 33217 c. I48.91, Z79.01, 33208 d. I48.91, I49.5, Z79.01, 33208

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."