mush69
Contributor
What code would I use for Repair of double chamber Right ventricle with Right Ventricular Muscle division and resection?
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Wiki CPT code help - What code would I use
- Thread starter mush69
- Start date
mush69
Contributor
Here is the op note. Thanks for taking the time to look at it for me.
PREOPERATIVE DIAGNOSIS: Subaortic Ventricular Septal Defect, Double Chamber Right Ventricle, Secundum Atrial Septal Defect
POSTOPERATIVE DIAGNOSIS: Subaortic Ventricular Septal Defect, Double Chamber Right Ventricle, Secundum Atrial Septal Defect
PROCEDURE: Procedure(s) with comments:
Ventricular Septal Defect Repair, using a Sauvage Patch, Repair of Double Chamber Right Ventricle with Right Ventricular Muscle Division and Resection, Congenital Transesophageal Echocardiogram, and Insertion of Invasive Lines
FINDINGS: Double chamber right ventricle, subaortic VSD, secundum ASD
Care was taken to avoid damage to the conduction system, phrenic nerves, and recurrent laryngeal nerve. No injury was noted.
TEE: Echo demonstrated good biventricular function - there were no residual or new defects.
BYPASS TIME: 110 min
CLAMP TIME: 95 min
CANNULATION: Distal ascending aortic; bicaval venous, LV vent via the ASD; proximal aortic root vent/cardioplegia catheter.
MYOCARDIAL PROTECTION: Myocardial protection was Del Nido solution administered antegrade cold in the root with good decompression of the ventricle maintained. Minimum systemic temperature was 32 C. Myocardial protection was felt to be excellent. RETROGRADE ADMINISTRATION: None.
ANTICOAGULATION: Systemic heparinization with adequate ACT before going on bypass.
MANAGEMENT OF AIR: Patient was in Trendelenburg. LV vent was turned off. The left heart was filled. The lungs were fully inflated. Heart was vigorously massaged. Root vent was on gently and subsequently increased. Integrity of the atrial septum was ensured after allowing egress of air to the right atrium. Management of air was felt to be excellent.
MODIFIED ULTRAFILTRATION: Standard technique performed.
WIRES/DRAINS: A2, V2, mediastinal x2 (Blake)
PERICARDIAL MEMBRANE: None.
DETAILS: After correctly identifying the patient and obtaining informed consent, the patient was brought to the operating room where the anesthesiologist established appropriate monitoring and general anesthesia. Safety time out was performed. Debriefing was performed. Antibiotics were administered. Right femoral central venous line and left femoral arterial line were placed using modified Seldinger technique. Preoperative TEE was performed. Patient was prepped and draped in the usual sterile fashion. Standard median sternotomy and subtotal thymectomy were completed followed by pericardiotomy and formation of the well. Anatomy was evaluated. Great vessels were mobilized. Heparin was administered. Pursestrings were placed followed by cannulation and initiation of bypass with subsequent full flow, good pressure, and appropriate cooling. The ductal ligament was ligated Cross-clamp was applied and cardioplegia administered. Venting was initiated. Caval snares were secured.
Right atriotomy was completed and intracardiac anatomy carefully evaluated. There was a small secundum ASD and a moderate to large subaortic VSD. Examination of the right ventricle showed a prominent are of muscle below the pulmonary valve with scar tissue ringing the os infundibulum. The muscle was divided and partially resected to open this area. The pulmonary valve was then visible. A Savage patch was trimmed to fit the VSD. The patch was sewn to the rim of the defect with a running Prolene suture. Care was taken to avoid the leaflets of the aortic valve. Under static testing the tricuspid valve was competent. The ASD was closed primarily after deairing.
Patient was rewarmed appropriately. Full de-airing was completed. Cardiac activity returned spontaneously in a synchronized fashion. The atriotomy was closed with running 6.0 Prolene suture. The SVC cannula was removed during an uneventful wean off bypass. Completion echocardiogram was performed. Modified ultrafiltration was performed. Protamine was administered and cannulae removed and pursestrings secured and reinforces where appropriate. Pacing wires and drains were placed and secured appropriately. Hemostasis was ensured. After correct count, the sternum was closed without hemodynamic change using #0 PDS interrupted followed by irrigation and closure of the soft tissues in layers with Vicryl suture. Sterile dressing was applied. The patient was prepared for transport to the PICU.
PREOPERATIVE DIAGNOSIS: Subaortic Ventricular Septal Defect, Double Chamber Right Ventricle, Secundum Atrial Septal Defect
POSTOPERATIVE DIAGNOSIS: Subaortic Ventricular Septal Defect, Double Chamber Right Ventricle, Secundum Atrial Septal Defect
PROCEDURE: Procedure(s) with comments:
Ventricular Septal Defect Repair, using a Sauvage Patch, Repair of Double Chamber Right Ventricle with Right Ventricular Muscle Division and Resection, Congenital Transesophageal Echocardiogram, and Insertion of Invasive Lines
FINDINGS: Double chamber right ventricle, subaortic VSD, secundum ASD
Care was taken to avoid damage to the conduction system, phrenic nerves, and recurrent laryngeal nerve. No injury was noted.
TEE: Echo demonstrated good biventricular function - there were no residual or new defects.
BYPASS TIME: 110 min
CLAMP TIME: 95 min
CANNULATION: Distal ascending aortic; bicaval venous, LV vent via the ASD; proximal aortic root vent/cardioplegia catheter.
MYOCARDIAL PROTECTION: Myocardial protection was Del Nido solution administered antegrade cold in the root with good decompression of the ventricle maintained. Minimum systemic temperature was 32 C. Myocardial protection was felt to be excellent. RETROGRADE ADMINISTRATION: None.
ANTICOAGULATION: Systemic heparinization with adequate ACT before going on bypass.
MANAGEMENT OF AIR: Patient was in Trendelenburg. LV vent was turned off. The left heart was filled. The lungs were fully inflated. Heart was vigorously massaged. Root vent was on gently and subsequently increased. Integrity of the atrial septum was ensured after allowing egress of air to the right atrium. Management of air was felt to be excellent.
MODIFIED ULTRAFILTRATION: Standard technique performed.
WIRES/DRAINS: A2, V2, mediastinal x2 (Blake)
PERICARDIAL MEMBRANE: None.
DETAILS: After correctly identifying the patient and obtaining informed consent, the patient was brought to the operating room where the anesthesiologist established appropriate monitoring and general anesthesia. Safety time out was performed. Debriefing was performed. Antibiotics were administered. Right femoral central venous line and left femoral arterial line were placed using modified Seldinger technique. Preoperative TEE was performed. Patient was prepped and draped in the usual sterile fashion. Standard median sternotomy and subtotal thymectomy were completed followed by pericardiotomy and formation of the well. Anatomy was evaluated. Great vessels were mobilized. Heparin was administered. Pursestrings were placed followed by cannulation and initiation of bypass with subsequent full flow, good pressure, and appropriate cooling. The ductal ligament was ligated Cross-clamp was applied and cardioplegia administered. Venting was initiated. Caval snares were secured.
Right atriotomy was completed and intracardiac anatomy carefully evaluated. There was a small secundum ASD and a moderate to large subaortic VSD. Examination of the right ventricle showed a prominent are of muscle below the pulmonary valve with scar tissue ringing the os infundibulum. The muscle was divided and partially resected to open this area. The pulmonary valve was then visible. A Savage patch was trimmed to fit the VSD. The patch was sewn to the rim of the defect with a running Prolene suture. Care was taken to avoid the leaflets of the aortic valve. Under static testing the tricuspid valve was competent. The ASD was closed primarily after deairing.
Patient was rewarmed appropriately. Full de-airing was completed. Cardiac activity returned spontaneously in a synchronized fashion. The atriotomy was closed with running 6.0 Prolene suture. The SVC cannula was removed during an uneventful wean off bypass. Completion echocardiogram was performed. Modified ultrafiltration was performed. Protamine was administered and cannulae removed and pursestrings secured and reinforces where appropriate. Pacing wires and drains were placed and secured appropriately. Hemostasis was ensured. After correct count, the sternum was closed without hemodynamic change using #0 PDS interrupted followed by irrigation and closure of the soft tissues in layers with Vicryl suture. Sterile dressing was applied. The patient was prepared for transport to the PICU.
Based on what I read below. I would suggest reviewing these CPT codes:
33612 for the Repair of right ventricle and
33641 for the Repair of the Atrial Septal Defect (ASD), secundum.
The VSD repair would be included in CPT 33612 above.
I'm not sure if Double Chamber and Double Outlet is considered the same thing but that's the way I'm reading this case.
Hope this helps!
mush69
Contributor
Thanks so much!!