Replacement of SVC

cmblocher

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I have a tricky op-note. Operation description: Homograph replacement of the SVC, placement of a conduit from his chest wall to his right atruim using homograft as a conduit to then place a dialysis catheter into his right atrium, inferior vena cava.

When I read the op- note I am baffled with how I should bill to reflect all the different procedures done.

After cardiopulmonary bypass institued this is where the op-note begings: I then snared the inferior vena cava. I was able to get control of the superior vena cava at the junction of the innominate in the jugular. I then performed snare there. I then performed an aortotomy. There was gross clot in the superior vena cava with scar about 1 cm distal to the innominate vein. This was full thickness scar. I then performed an anastomosis, first at the atrium sewing a 21 homograft into the right atrium using 4-0 surgipro. At the completion of this, I then sewed it as a beveled graft into the innominate jugular superior vena cava junction. This anastomosis was approximately 2 cm in diameter. I wanted to maintain a catheter out of his upper veins due to the fact that his innominate only measured approximately 1.5 cm in diameter. I felt that it would be small and that he would run the risk of further clot. At the completion of this anastomosis, we were able to then come down off bypass without any difficulty. Once off bypass, we obtained hemostasis. We made the patient anticoagulated. I then took the head vessels off the remainder of the homograft, sewed 3 head vessels together to make a long conduit. I sewed the anastomosis to the oracle of the right atrium, brought this then to the chest wall, tunnelled it through the chest wall and through this I was able to then place a dialysis catheter down into the superior vena cava. We then gave protamin, obtained hemostasis, decannulated the patient. We closed the chest. The catheter was flushed and irrigated easily, and withdrew blood easily. We then closed the chest in 3 layers. The patient went to ICU in good stable condition after 2 chest tubes were placed.

I was thinking maybe 34502 for the SVC homograft. But unsure how to bill the the tunnelled graft from chest wall to atrium and the catheter placement.

Thanks for any help!
 

cmblocher

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I guess no one is familiar with this type of surgery. Does anyone know of a resource that may help me?
 

lisigirl

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I have a question, what are they treating with this procedure?? It sounds crazy. Have you talked to the surgeon because he/she may be able to help you picture it better. I'm certainly having a hard time understanding what they did!

You might want to try the Society of Thoracic Surgeons website. You can email coding questions to them. It might take awhile to hear back though.

I think the 34502 might be right but I think you'll need an unlisted code as well (or maybe a modifier 22?).

Good luck. If you get an answer, I'd love to know what it is. Is there a name for this procedure?

Lisi, CPC
eharkler@nmh.org
 
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