AHA Coding Clinic® for ICD-9 - 2007 Issue 1; Ask the Editor

Left Ventricle Epicardial Lead Placement Following Failed Attempt

A patient with acute on chronic diastolic congestive heart failure and congestive cardiomyopathy had an upgrade from a pacemaker to a biventricular device with defibrillator. During the initial admission, the biventricular device and two leads were implanted. However, after multiple attempts, third lead insertion into the left ventricle (LV) was unsuccessful. The patient is now being readmitted two weeks later for placement of LV epicardial lead via thoracotomy. Coding Clinic Third Quarter 2005, pages 3-6, only addressed the procedure code assignments. Would an aftercare code (V53.39) be appropriate? What is the correct principal diagnosis for the second admission for third (epicardial) lead placement? ...

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