Pt with severe mitral regurg and severe 2-vessel CAD. Pt taken to OR for mitral valve repair and CABG. My surgeon did a simple mitral valve repair first and then the CABG. Pt weaned from bypass and it was noted the mitral valve had a moderate leak so decision to go back on bypass and do mitral valve replacement. Do I code the repair 33426 and the replacement 33430 and if so which do I put the 51 modifier on?? I haven't had this scenario before and I'm just not sure how to code this. Thanks for your help!!