Posterior Leaflet Augmentation in Complex MV Repair

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Garner, NC
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My surgeon did a complex mitral valve repair. He also had to augment the posterior leaflet with an autologous pericardial patch across the entire length of the posterior leaflet.

Per his OP Note the findings were: "The anterior leaflet was normal as were it's cords and subvalvular structures. The papillary muscles were all normal. The posterior leaflet was normal and the cords appeard normal caliber with normal papillary muscles, however, there was retraction of the posterior leaflet across the whole width of the P2 leaflet mostly but also part of P1 and P3 where it joined P2. The AP diameter was dilated and with the ring in position the mitral regurgitation was significantly improved, however I continued to have two significant jets with testing. These remained in spite of closure of the clefts between P1 and P2 and between P2 and P3. At that point I went ahead and augmented the posterior leaflet with an autologous pericardial patch that was prepared with 2% glutaraldehyde. The patch added 5 mm of length to the entire breadth of the posterior leaftlet and gave me good coaptation service between anterior posterior leaflet and no significant mitral regurgitation by testing."

I would appreciate any suggestions on how I need to code this procedure. I know I will use 33427 for the complex MV Repair portion just can't figure out the rest!!

Thanks in advance for any help you can give me!
 
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