We are having an internal battle on what codes you can use for a cardiopulmonary bypass that was done after a valve replacement. The patient was experiencing increased bleeding from the chest tubes with signs of cardiac tamponade so they were brought back to the OR. The two codes I came up with are 33954 or 33956 - for this case below, I am leaning more towards 33956-78-. Help!
Preoperative Diagnosis
cardiac tamponade
Procedure Performed
redo sternotomy, cardiopulmonary bypass
Indications for operation
This 72-year-old status post aortic valve replacement and ascending aorta replacement. The patient
was brought to the ICU with peak and experiencing increased bleeding from the chest tubes along
with signs of cardiac tamponade. The patient was taken back to the operating room emergently.
Description of operative procedure
On arrival to the operating room the patient's blood pressure had decreased dramatically. He was
prepped and draped in usual sterile fashion. The sternotomy was reperformed . Of clot was
evacuated but the patient required cardiac massage. He did not respond to this. Heparin was given
and the groin incision was reopened and patient was arterially cannulated at that site. A venous
cannula was placed in the right atrium and the patient was placed on cardiopulmonary bypass. The
patient was then rewarmed. There was some evidence of bleeding at the distal anastomosis
posteriorly. For this reason that area of the anastomosis was completely visualized by removing all
posterior tissue and then a total of 5 pledgeted 4-0 Prolene sutures on SH needles were placed to
buttress that anastomosis at that site. Once this was done hemostasis was improved. The patient
was weaned from cardiopulmonary bypass and decannulated. The chest tubes were placed in their
normal position the patient was closed in the standard fashion with sternal wire and 2 0
subcutaneous suture as well as fascia suture with 1. Ethibond. In the groin patient was
decannulated from the right common femoral the right common femoral was then repaired with 5
interrupted 5 0 Prolene sutures on RB 2 needles. Then that groin incision was closed with 2-0 Vicryl
in 2 layers and then staples on both incisions. Dry sterile dressings were applied the patient was
taken back to ICU 6. Another discussion was undertaken with the patient's representative. Bleeding
seemed improved.
Preoperative Diagnosis
cardiac tamponade
Procedure Performed
redo sternotomy, cardiopulmonary bypass
Indications for operation
This 72-year-old status post aortic valve replacement and ascending aorta replacement. The patient
was brought to the ICU with peak and experiencing increased bleeding from the chest tubes along
with signs of cardiac tamponade. The patient was taken back to the operating room emergently.
Description of operative procedure
On arrival to the operating room the patient's blood pressure had decreased dramatically. He was
prepped and draped in usual sterile fashion. The sternotomy was reperformed . Of clot was
evacuated but the patient required cardiac massage. He did not respond to this. Heparin was given
and the groin incision was reopened and patient was arterially cannulated at that site. A venous
cannula was placed in the right atrium and the patient was placed on cardiopulmonary bypass. The
patient was then rewarmed. There was some evidence of bleeding at the distal anastomosis
posteriorly. For this reason that area of the anastomosis was completely visualized by removing all
posterior tissue and then a total of 5 pledgeted 4-0 Prolene sutures on SH needles were placed to
buttress that anastomosis at that site. Once this was done hemostasis was improved. The patient
was weaned from cardiopulmonary bypass and decannulated. The chest tubes were placed in their
normal position the patient was closed in the standard fashion with sternal wire and 2 0
subcutaneous suture as well as fascia suture with 1. Ethibond. In the groin patient was
decannulated from the right common femoral the right common femoral was then repaired with 5
interrupted 5 0 Prolene sutures on RB 2 needles. Then that groin incision was closed with 2-0 Vicryl
in 2 layers and then staples on both incisions. Dry sterile dressings were applied the patient was
taken back to ICU 6. Another discussion was undertaken with the patient's representative. Bleeding
seemed improved.