Question Someone please help!! New to TAVR and so confused!!

debbyallen

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I have the following report that I do not know for sure that I am coding correctly. Someone? Anyone?

Using DX:

I35.0 AND Z00.6

I am coding it this way:

33361 62:Q0
33210 59
76937 26:59
75630 26

Also, can I bill the C1884? If so does it need a modifier and what is the reimbursement rate?

Cardiac Cath Lab OPERATIVE REPORT:
TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR), percutaneous, transfemoral approach.

Implant Device Name/Size: Successful TAVR procedure in the cath lab, implantation of a 29 mm Edwards Sapien
III transcatheter heart valve, via a transfemoral approach, under general anesthesia and TEE guidance. No complications.
Patient extubated in the cath lab, woke up and moving all extremities and responding to commands in the cath lab post
procedure.

Procedure: Transcatheter Aortic Valve Replacement (TAVR)
Sedation method: General Anesthesia with Endotracheal Intubation (please refer to Anesthesia procedure report)

1. Right and left common femoral arterial access with ultrasound guidance
2. Right common femoral venous access with ultrasound guidance
3. Right radial arterial access w􀆞h ultrasound guidance
4. Placement of a transvenous temporary P􀆦cemaker into the Right Ventricle.
5. Placement of a pigtail catheter into the aortic root
6. Interpretation of pre-, intra-and post -operative transesophageal echocardiographic images. Dr. R
7. Aortic Arteriography
8. Placement of a 16 Fr eSheath.
9. Heparin given for anticoagulation with target ACT > 250 seconds.
10. Transcatheter aortic valve replacement completed using a 29 mm Edwards Sapien III bioprosthetic valve (left common
femoral percutaneous approach).
11. Dual Perclose ProGlide used for successful in left common femoral arterial closure and hemostasis. Right CFA and CFV closed w􀅪h Perclose
12. Embolization protective system through R radial artery: C1884

Arterial and venous access was then obtained via the right femoral artery and vein with placement of a 6F sheath (artery) left
and a 6F sheath (vein) left inserted under ultrasound guidance. Lidocaine was infiltrated into the right groin. Under ultrasound guidance access obtained to the left common femoral artery using a modified Seldinger technique where we then placed a 6
French sheath. Left and right common femoral angiograms were performed. Under ultrasound guidance lidocaine was
administered to the right wrist where we then obtained access to the right radial artery. 6 French sheath was then
placed and radial cocktail was given w􀅪hout any heparin. 2 preclosed sutures were then deployed to the left common femoral arterial sheath. Next we advanced a multipurpose catheter over a J-wire into the descending aorta. The wire was then removed catheter was flushed we advanced a Lunderquist wire into the descending aorta. The multipurpose was then removed 6 French sheath was then removed and the Edwards sheath was then advanced. The sheath was flushed and sutured into place. Next we advanced a pigtail catheter over a J-wire Into the ascending aorta. An aortogram was performed identifying the branch
arteries. It was noted that the left internal carotid artery was occluded. We then proceeded to protect the right innominate
artery. We advanced a JR4 diagnostic catheter over a J-wire into the radial sheath and subsequently placed JR4 catheter into the ascending aorta. We then advanced a
Choice PT extra support wire. The JR4 diagnostic catheter was then removed. Over this wire we then advanced a
sentinel embolization protection device. We deployed the filter into the right innominate 2 cm above the takeoff. And placed
the distal catheter into the ostium of what used to be the left common carotid artery.

Next the pigtail catheter was then placed down into the right coronary cusp. Aortic root angiogram was performed in the
coplanar view. Next AL-1 diagnostic catheter over J-wire was advanced into the aortic root. Using a straight wire we crossed
into the left ventricle where the AL-1 was then advanced. The AL-1 was exchanged over exchange length J-wire. For pigtail
catheter. Pressures were obtained. We then ad􀂟anced a computer a wire into the left ventricle and the pigtail catheter was then removed. The 29 mm valve was then advanced into the sheath. In the descending aorta we brought the balloon apparatus back into the valve. Then proceeded to advance acrqss the aortic arch in a LAO position. Taking caution to not over flex the catheter against the calcium. We were able to go across the aortic valve. Another aortic root angiogram performed. Breaths were held. Rapid pacing initiated aortogram was performed, valve was then deployed successfully, pacing was then turned off. Aortic root angiogram was then performed. Showing minimal aortic regurgitation and perfusion of the coronary arteries. The device was
then pulled back into the descending aorta.
TEE was done used to evaluate with very minimal aortic regurgitation. No new pericardial effusion.
The valve delivery system was then removed. J-wire was advanced over the sheath. The sheath was then removed and we
closed the Perclose sutures. Sentinel device was retrieved and evaluated for any debris, no debris seen. Peripheral angiogram
runoff with Pigtail catheter confirmed no vascular complications. Arterial and venous sheaths were removed with Perclose closure deployment. TR band placed for R radial arterial sheath.
 

Jim Pawloski

True Blue
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Ann Arbor
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You cannot code for temporary pacemaker as it is bundled into the procedure. The aortogram was probable used for the closure devices as I do not see enough information to support using 75630.

HTH,
Jim Pawloski, CIRCC
 
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