Code for Repair of Paravalvular Leak?


Glenville, NY
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I need assistance coding the following operative note. I will not give the whole note but enough that you can get the general idea of the surgery. Patient is s/p aortic valve replacement and mitral valve replacement now presenting with a paravalvular leak. I am struggling with which code would be appropriate but thinking possibly 33322? Any advice would be greatly appreciated.

POSTOPERATIVE DIAGNOSES : Status post redo sternotomy and ascending aortic
replacement and St. Jude mechanical aortic valve replacement with paravalvular leak,
prior mechanical St. Jude mitral valve replacement.

OPERATIVE PROCEDURE : Twice redo sternotomy, repair of paravalvular leak.

INDICATIONS FOR PROCEDURE : Patient is about a month out from redo sternotomy
and ascending aortic and aortic valve replacement with mechanical St. Jude valve.
Five years ago, he had undergone emergency mechanical mitral valve replacement with
St. Jude valve for ruptured chordae and acute MR. On postoperative followup, he was
found to have a murmur and workup revealed a substantial paravalvular leak around
the aortic valve. He was advised reexploration and repair of paravalvular leak.

FINDINGS DURING THE PROCEDURE : As expected dense scar tissue was present in the
mediastinum and in the pericardial space. The aorta in the right side of the heart
were the only areas dissected out to accomplish the procedure. The leak was present
in the non-coronary cusp area. The sutures were intact. However, there was a gap
between the sewing cuff of the St. Jude aortic valve and the aortic annulus where
the pledgets were. The mechanical aortic valve was not seated properly in this
area. The rest of the sewing ring was nicely seated and well apposed to the
annulus. Multiple interrupted pledgeted sutures were placed to tack the aortic wall
and the annulus back to the sewing ring in the non-coronary cusp area. The sutures
were tied down on pledgets outside the aortic wall to tack the sewing cuff firmly to
the end of the center of the aortic wall leaving no gaps. Total cross-clamp time
was 95 minutes. Total bypass time was 171 minutes. Postoperative TEE showed trace
amount of color flow indicating a trace paravalvular leak, which was deemed non-
physiological. Good LV function was observed. The patient was transferred on Neo-
Synephrine, nitroglycerin, Precedex, and insulin drips.


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Related question

I would like to know if anyone knows what CPT code you would you if you are doing the procedure percutaneous? So it would be a percutaneous perivalve leak closure?