Wiki Mitral Valve Leaflets Vegetations Biopsies

[cmacpc]

Need some help with this one:

Dr. gave me code 33120??
Dr did MVR 33430 along with CABG single vessel 33533 on pump. There is one stmnt on the op rpt as follows: " The mitral valve leaflets were found to be destroyed w/two large vegetations on the anterior and posterior leaflets. The mitral valve leaflets along w/chordee were excised in total with plan not to leave any nidus for recurrent infection. Leaflets were sent to Pathology and Microbiology."

TIA

 

[jewlz0879]

Without the full report I can't be sure but my question is: did he do a repair or replacement? When I see "chordee" or "chords" this denotes 'radical reconstruction' 33427. I do not see documentation (with what's posted) for billing 33120.

My two cents.

 

[cmacpc]

These are the main parts to the report any help or thoughts are greatly appreciated!
Thanks

Sternotomy incision was made. Extensive adhesions between pericardium and epicardium w/evidence of pericarditis. These adhesions were released and the heart was exposed. We then raised the left internal mammary artery as a pedicle flap based proximally and prepared it for use as a vascular conduit. We heparinized the patient. The superior and inferior aorta were cannulated separately. A retrograde cardioplegia cath was placed in coronary sinus for retrograde cardioplegia delivery. Another cath was placed in the ascending aorta for antegrade cardioplegia delivery and also serve as root vent. Pt was place on bypass & cooled down to 28 degrees centegrade. Aorta was cross clamped & heart was arrested with induction dose of cardioplegia.
With heart fully arrested the LIMA was anastamosed to LAD coronary artery in end to end fashion. The mammary pedicle was tacked to the epicardium. A bulldog clamp was placed on the mammary artery after which we applied the umbilicle taped around the superior and inferior vena cavae, and the snared them. We then performed a left left artiotomy in the left wall extending for the right pulmonary vein downward and exposed the mitral valve.The mitral valve leaflets were found to be destroyed w/two large vegetations on the anterior and posterior leaflets. The mitral valve leaflets along w/chordee were excised in total with plan not to leave any nidus for recurrent infection. Leaflets were sent to Pathology and Microbiology."
We then sized the Mitral valve anulus to size 31mm St. Jude tissue valve, after which we placed 2-0 pledgeted sutures in the mitral valve anulus with the pledgets placed on the atrial side. After that we then placed a left ventricular vent across the mitral valve prosthesis and exteriorized it through a pursestring suture in the right superior pulmonary vein. The left artiotomy was closed.

 

[lisigirl]

Just code the MVR and cabg (33430, 33533) as you did. You wouldn't charge separately for the biopsies, if that is what you're asking. The surgeon had already removed the leaflets to replace the valve.

Lisi, CPC
eharkler@nmh.org