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Wiki MV repair/MV replacement

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dvance4210

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The surgeon performed a mitral valve repair with annuloplasty ring...the patient was weaned from bypass, a PEE was performed and there was an obvious leak. Patient went back on pump to re-evaluate the situation, no structural problem was noticed. They performed a Seldinger test again and no leak was notice but proceeded to take down the repair and replace the mitral valve.

Is 33426 and 33430 appropriate to bill. Should a modifier of some sort be added.

Thanks for your input!

Dorinda
 
You can only bill for the more extensive procedure which would be 33430. If your surgeon performed a complex valve repair first (in other words, he did more than just place a ring, he plicated the annulus or moved leaftlets before placing the ring), then I would add modifier 22 to 33430. My letter supporting the modifier would state that the physician had completed a complex valve repair prior to replacing the entire valve (I do this currently and always get paid for the modifier).

If, however, your surgeon only placed a ring and no reconstruction was required and then he realized the valve would need to be replaced, I would probably just bill 33430, no modifier.

Lisi, CPC
eharkler@nmh.org
 
Thanks for the reply...the surgeon had plicated the annulus and I ended up billing it as a 33430-22 and sent the op note with it.

Dorinda
 
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