Hi all:
Is the cpt 33641 ok for the below case?can we separately code femoral artery and vein reconstruction along with this? Please help
Procedures Performed: Minimally invasive ASD closure with cannulation of right jugular vein and cannulation of right common femoral artery and right common femoral vein.
Procedure in Detail: In uncomplicated general anesthesia, 30-degree left-sided thoracotomy position, we made about 4 cm long incision in the right groin in the skin line to expose the common femoral artery and the common femoral vein. Thereafter, we performed a 6 cm long mini sternotomy exactly in the skin fold under the right breast and could expose the heart from the right side. We could identify the phrenic nerve very well. After full heparinization, Dr. Sadik inserted a venous cannula through the jugular vein for cardiopulmonary bypass, which we then established. We cooled the patient to 34 degrees centigrade. After resection of some pericardial fat, we opened the right pericardium longitudinally and exposed it with stay sutures. Then, we cross-clamped the heart, instilled 1 L of crystalloid cardioplegia for an ideal isoelectricity of 30 minutes. We opened the right atrium from the right atrial appendage towards the inferior vena cava, which we surrounded before like we did for the SVC. We identified an approximately 1.6 cm measuring ASD too with good margins. This was then being closed with 4-0 polypropylene double running suture. We deaired the left atrium and right atrium were then closed, right atrium with 4-0 polypropylene running suture. We then removed the cardioplegia cannula and closed this one as well. We opened the cross clamp.
We started rewarming the patient and after a few seconds the heart established a regular sinus rhythm. After full rewarming, we then weaned the patient off cardiopulmonary bypass without any difficulties. We decannulated the groin vessels and the right jugular vein cannulas and reversed heparin with protamine chloride. We then reconstructed the right common femoral artery with 5-0 polypropylene suture as well as the right common femoral vein with 5-0 polypropylene suture. In the groin, we inserted a 12-French Redon drain and closed the skin and subcutaneous tissue in several layers. After securing hemostasis, we then closed the right pericardium with four single Vicryl stitches to allow drainage and also avoid herniation of the heart. We inserted one 28-French chest tube to the right costophrenic angle. We closed the chest with pericostal sutures, several muscle layers and subcutaneous and intracutaneous skin tissue. The patient has been stable throughout the procedure and then has been transferred to ICU for further treatment.
Is the cpt 33641 ok for the below case?can we separately code femoral artery and vein reconstruction along with this? Please help
Procedures Performed: Minimally invasive ASD closure with cannulation of right jugular vein and cannulation of right common femoral artery and right common femoral vein.
Procedure in Detail: In uncomplicated general anesthesia, 30-degree left-sided thoracotomy position, we made about 4 cm long incision in the right groin in the skin line to expose the common femoral artery and the common femoral vein. Thereafter, we performed a 6 cm long mini sternotomy exactly in the skin fold under the right breast and could expose the heart from the right side. We could identify the phrenic nerve very well. After full heparinization, Dr. Sadik inserted a venous cannula through the jugular vein for cardiopulmonary bypass, which we then established. We cooled the patient to 34 degrees centigrade. After resection of some pericardial fat, we opened the right pericardium longitudinally and exposed it with stay sutures. Then, we cross-clamped the heart, instilled 1 L of crystalloid cardioplegia for an ideal isoelectricity of 30 minutes. We opened the right atrium from the right atrial appendage towards the inferior vena cava, which we surrounded before like we did for the SVC. We identified an approximately 1.6 cm measuring ASD too with good margins. This was then being closed with 4-0 polypropylene double running suture. We deaired the left atrium and right atrium were then closed, right atrium with 4-0 polypropylene running suture. We then removed the cardioplegia cannula and closed this one as well. We opened the cross clamp.
We started rewarming the patient and after a few seconds the heart established a regular sinus rhythm. After full rewarming, we then weaned the patient off cardiopulmonary bypass without any difficulties. We decannulated the groin vessels and the right jugular vein cannulas and reversed heparin with protamine chloride. We then reconstructed the right common femoral artery with 5-0 polypropylene suture as well as the right common femoral vein with 5-0 polypropylene suture. In the groin, we inserted a 12-French Redon drain and closed the skin and subcutaneous tissue in several layers. After securing hemostasis, we then closed the right pericardium with four single Vicryl stitches to allow drainage and also avoid herniation of the heart. We inserted one 28-French chest tube to the right costophrenic angle. We closed the chest with pericostal sutures, several muscle layers and subcutaneous and intracutaneous skin tissue. The patient has been stable throughout the procedure and then has been transferred to ICU for further treatment.