bennieyoung
Guru
My auditor wants me to add T82.857A. The physician documents "Prosthetic mitral valve stenosis." This should be listed as the first listed diagnosis per coding guidelines "code also."
I coded this 33430 and 33530 with I34.2 and I27.20. Is she right? I was thinking for some reason that the T82.857A was used when a stent was inserted. Gosh, I feel like I have dropped the ball with this one.
PREOPERATIVE DIAGNOSIS: Prosthetic mitral valve stenosis.
POSTOPERATIVE DIAGNOSIS: Prosthetic mitral valve stenosis.
PROCEDURE PERFORMED: Mitral valve re-replacement with 33mm Mosaic porcine valve
FINDINGS: The valve was densely incorporated. On removal, it appeared that residual mitral leaflet tissue which had been preserved from the previous operation had caused ingrowth over the struts limiting valve leaflet motion. There was also mild-to-moderate calcification of the leaflets which were themselves were somewhat stiff suggesting the mechanism of failure was a combination of early structural valve deterioration and ingrowth of native preserved leaflet tissue.
DESCRIPTION OF PROCEDURE: The patient was taken operating placed on the operative table in supine position. After induction of general anesthesia and single-lumen endotracheal tube intubation, patient was prepped and draped sterilely. The previous incision was opened and the reoperative sternotomy was performed after removal of the wires. Once the chest was opened using an oscillating saw we dissected the heart, exposing the SVC, IVC, and aorta. The patient was next fully heparinized and cannulated with Sarns 8.0 soft flow aortic cannula as well as 24-French and 28-French SVC and IVC cannulas.
Cardiopulmonary bypass was instituted. The remainder of the heart was dissected to expose the left atrium. Next, the cross-clamp was applied and the heart was arrested with 1 L of Del Nido solution. The valve was inspected. It was densely incorporated into the anulus and atrium. We meticulously dissected the valve and removed this along with sutures and pledget material. Once this was completed, there was noted to be a fairly large groove between the atrium and ventricle. Continuity between these 2 chambers appeared as though it could be somewhat compromised. We sized this to a 33 mm mosaic porcine valve. Sutures were replaced around the annulus with great care to close this gap and posteriorly it was reinforced with bovine pericardium. Once the sutures had been placed, we seated the valve without difficulty and secured in place with a cor knot device. Left atrium was then closed. The patient was separated from cardiopulmonary bypass without difficulty. The post pump transesophageal echo shows no significant paravalvular leak. There was normally functioning bioprosthetic prosthesis in the mitral position. Pulmonary artery pressures were decreased by half. The protamine was then administered and the patient decannulated. Left right and mediastinal chest tubes were placed. Once hemostasis had been achieved, the heart was recovered with pericardium and fat. The chest was closed with #6 stainless steel wires. Subcutaneous tissue and skin were closed with running Vicryl suture.
PROCEDURE PERFORMED: Redo sternotomy and mitral valve re-replacement using a 33 mm Medtronic Mosaic porcine valve.
HISTORY: The patient is a 71-year-old gentleman who underwent mitral valve replacement approximately 5 years ago with an Edwards Magna mitral bovine pericardial valve. He has since developed severe prosthetic mitral stenosis. He is highly symptomatic and has severe pulmonary hypertension. He was recommended undergo surgical valve re-replacement.
I coded this 33430 and 33530 with I34.2 and I27.20. Is she right? I was thinking for some reason that the T82.857A was used when a stent was inserted. Gosh, I feel like I have dropped the ball with this one.
PREOPERATIVE DIAGNOSIS: Prosthetic mitral valve stenosis.
POSTOPERATIVE DIAGNOSIS: Prosthetic mitral valve stenosis.
PROCEDURE PERFORMED: Mitral valve re-replacement with 33mm Mosaic porcine valve
FINDINGS: The valve was densely incorporated. On removal, it appeared that residual mitral leaflet tissue which had been preserved from the previous operation had caused ingrowth over the struts limiting valve leaflet motion. There was also mild-to-moderate calcification of the leaflets which were themselves were somewhat stiff suggesting the mechanism of failure was a combination of early structural valve deterioration and ingrowth of native preserved leaflet tissue.
DESCRIPTION OF PROCEDURE: The patient was taken operating placed on the operative table in supine position. After induction of general anesthesia and single-lumen endotracheal tube intubation, patient was prepped and draped sterilely. The previous incision was opened and the reoperative sternotomy was performed after removal of the wires. Once the chest was opened using an oscillating saw we dissected the heart, exposing the SVC, IVC, and aorta. The patient was next fully heparinized and cannulated with Sarns 8.0 soft flow aortic cannula as well as 24-French and 28-French SVC and IVC cannulas.
Cardiopulmonary bypass was instituted. The remainder of the heart was dissected to expose the left atrium. Next, the cross-clamp was applied and the heart was arrested with 1 L of Del Nido solution. The valve was inspected. It was densely incorporated into the anulus and atrium. We meticulously dissected the valve and removed this along with sutures and pledget material. Once this was completed, there was noted to be a fairly large groove between the atrium and ventricle. Continuity between these 2 chambers appeared as though it could be somewhat compromised. We sized this to a 33 mm mosaic porcine valve. Sutures were replaced around the annulus with great care to close this gap and posteriorly it was reinforced with bovine pericardium. Once the sutures had been placed, we seated the valve without difficulty and secured in place with a cor knot device. Left atrium was then closed. The patient was separated from cardiopulmonary bypass without difficulty. The post pump transesophageal echo shows no significant paravalvular leak. There was normally functioning bioprosthetic prosthesis in the mitral position. Pulmonary artery pressures were decreased by half. The protamine was then administered and the patient decannulated. Left right and mediastinal chest tubes were placed. Once hemostasis had been achieved, the heart was recovered with pericardium and fat. The chest was closed with #6 stainless steel wires. Subcutaneous tissue and skin were closed with running Vicryl suture.
PROCEDURE PERFORMED: Redo sternotomy and mitral valve re-replacement using a 33 mm Medtronic Mosaic porcine valve.
HISTORY: The patient is a 71-year-old gentleman who underwent mitral valve replacement approximately 5 years ago with an Edwards Magna mitral bovine pericardial valve. He has since developed severe prosthetic mitral stenosis. He is highly symptomatic and has severe pulmonary hypertension. He was recommended undergo surgical valve re-replacement.