Section G has been renamed Device Implant-Explant. We will be discussing Primary Pacing Mode Sequence 14735. All elements highlighted in yellow indicate a change from Version 2.2. Code the primary pacing mode documented in the current procedure note by the clinician in the device log and or the procedure log. Please do note we are only capturing the most common pacing modes. If the documented pacing mode is not available in the selections provided, please leave Sequence 14735 blank. Each pacing mode is identified by a series of letters. The first letter identifies the chamber paced. An A indicates there is pacing in the atrium, a V indicates there is pacing in the ventricle, a D would indicate there's pacing in both the atrium and ventricle. The second letter identifies the chamber sensed or the mode of sensing. A indicates that there is sensing in the atrium, V indicates there's sensing in the ventricle, and D indicates there's sensing in both the atrium and the ventricle. The third letter identifies the response to sensing. It indicates how the pacemaker responds to the presence or absence of an intrinsic beat. I means if an intrinsic beat is sensed, a paced beat will be inhibited. T means if an intrinsic beat is not sensed, a paced beat will be initiated. R identifies rate response mode. Rate response pacing is used to identify changes in physiologic needs and increases the pacing rate. A pacemaker programmed as VVI paces and senses in the right ventricle. When it senses an intrinsic QRS beat, it inhibits the paced right ventricular beat. Rate response is used to identify changes in physiologic needs and increases the pacing rate. The VVI mode does not trigger an AV delayed followed by an intrinsic P wave as there is no P wave tracking. In the DDIR mode, there's the ability to pace and sense in both the right atrium and ventricle. When it senses an intrinsic atrial or ventricular beat, it inhibits the paced right atrial or ventricular beat. Rate response pacing is used to identify changes in physiologic needs and increases the pacing rate. A pacemaker programmed as DDD paces and senses in both the right atrium and ventricle. A sensed intrinsic P wave and QRS complex can inhibit pacing. In addition, an intrinsic P wave can trigger a paced QRS beat, also known as P wave tracking resulting in a consistent AV delay. Again, rate response mode is used to identify changes in physiologic needs and increase the pacing rate. The goal of the DDDR is to maintain AV synchrony whenever possible. In the AAIR mode, there is the ability to pace and sense in the right atrium. When it senses an intrinsic atrial beat, it inhibits the paced right atrial beat. Rate response is used to identify changes in physiologic needs and increase the pacing rate. The DDDR AAIR mode promotes intrinsic conduction by reducing unnecessary right ventricular pacing. These modes provide atrial-based pacing with ventricular backup. If AV conduction is lost, the device is designed to switch back to DDDR mode. Periodic conduction checks are performed, and if the AV conduction resumes, the device switches back to AAIR mode. Rate response pacing is used to identify changes in physiologic needs and increase the pacing rate. Over recent years, it has become evident that even though symptomatic bradycardia has been treated effectively with cardiac pacemakers, long-term pacing of the RV apex has resulted in negative effects on cardiac function and structure due to ventricular dyssynchrony, as well as adverse outcomes such as atrial fib, heart failure, and death. Subsequently, manufacturers have developed several RVPP algorithms under their own proprietary names such as, but not limited to, MVP or Rhythm IQ, which would still be coded as RVPP sequence 14735. The goal of RVPP algorithm is to prolong AV intervals to allow the device to search for and allow intrinsic AV conduction. Therefore, when the device is programmed with the right ventricular pacing prevention algorithm, this will take precedence over coding the mode. Example, if the mode is DDDR or DVIR with a programmed RVPP algorithm, please code RVPP sequence 14735 primary pacing modes.

patient evaluation

risk stratification

medical records

clinician documentation

coding instructions

primary pacing modes

device implant-explant

healthcare field

coding primary pacing mode

procedure notes