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help please - Procedures

  1. #1
    Unhappy help please - Procedures
    Exam Training Packages
    Procedures:

    Resection of type a and arch dissection.

    Reconstruction with aortic valve repair.

    A 24-mm supra-annular hemasheild ascending graft.

    Artery reconstruciton with 24-mm hemashield graft and reimplantation, left common carotid to the neo-arch.

  2. Default
    I think I need more info to answer this question. Was the transverse arch replaced or did the surgeon just do a hemi-arch? In other words, did the surgeon need to reimplant all of the great vessels or did he just replace the bottom part of the arch? If it was just a hemi-arch graft, do not charge separately for this. If the transverse arch was replaced, use code 33870.

    As for the ascending aorta with AVR, was the aortic root replaced as well? If so, I would bill 33863.

    If only the ascending aorta and valve were replaced and not the root, I would use 33860 and 33405.

    Let me know if this helps. If not, I may need to see the op note.

    Lisi, CPC

  3. #3
    Default
    After gneral endotracheal anesthesia was performed, he was prepped and draped in the usual sterile fashion. He was heparinized and we attempted to cannulate ther right femoral artery; however, this was not possible due to flow constraints and we cannulatedhis axillary artery, placed a 22- french arterial line on the right side. His right atrium was cannulated for the venous return.

    After the patient was established, placed on cardiopulmonary bypass, he was cooled to 18 degrees celsius. His head was packed in ice. He was placed on phenobarbital, and was given Solu-Medrol. We then rested the heart, cross clamped the aorta, and resected the aorta and inspected the ascending aorta noting htat the tear did not extend down into his valve. There was a small valve of insufficiency which was controlled with a 4-0 prolene pledgeted suture to tighten up the commissure between the noncoronary and left coronary. We then inserted a 24-mm Hemashield graft in place with a felt strip on the outside and the hemashield patch on the inside placed with running 3-0 prolene suture. We then removed the clamp when all structures were rested for approximately 68 minutes and freed up the arch, resected the tears,, and using a 24 hemashield graft, sewed this tothe descending thoracic aorta with a felt strip in the outside and making the button for the arch to be sewn inplace with a running 3-0 prolene suture. this was also buttressed with felf strips on both sides. The neo-arch and neo-ascending aorta was brought together with a running 4-0 prolene suture. The patient was warmed to 37 degrees. Two RV wires were placed on the heart. Some bleeding noted along the anomaly area was controlled with figure-of-eight 4-0 prolene suture. We de-aired the patient with the left ventricular vein and asceding root.vein. After this was accomplished, we allowed the patient to begind weaning from cardiopulmonary bypass. as he was separated from cardiopulmnary bypass and began injecting, we noticed significant amout of blood coming from his ascending aorta repair in the area of the septum. This continued to come despite going back on polyp and trying to repair this with pledgeted 3-0 prolene sutures. We were able to wean the patient again and on massive inotropic support, he still began tearing this and exsanguinated. We were unable to repair this despite all our interventions. He was pronounced dead.

    I hope you can help I appreciate so very much
    Quote Originally Posted by lisigirl View Post
    I think I need more info to answer this question. Was the transverse arch replaced or did the surgeon just do a hemi-arch? In other words, did the surgeon need to reimplant all of the great vessels or did he just replace the bottom part of the arch? If it was just a hemi-arch graft, do not charge separately for this. If the transverse arch was replaced, use code 33870.

    As for the ascending aorta with AVR, was the aortic root replaced as well? If so, I would bill 33863.

    If only the ascending aorta and valve were replaced and not the root, I would use 33860 and 33405.

    Let me know if this helps. If not, I may need to see the op note.

    Lisi, CPC

  4. Default
    I think its 33870, 33860 and 33400.

    Lisi, CPC

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