AAPC - Back to school
Results 1 to 3 of 3

Thread: Replacement of SVC

  1. #1

    Default Replacement of SVC

    AAPC: Back to School
    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!

  2. #2


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

  3. #3


    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

Similar Threads

  1. SVC filter
    By lisammy in forum Interventional Radiology
    Replies: 6
    Last Post: 10-17-2010, 04:04 PM
  2. Replies: 1
    Last Post: 09-29-2010, 06:03 AM
  3. SVC gram
    By prabha in forum Interventional Radiology
    Replies: 0
    Last Post: 08-05-2010, 06:36 AM
  4. stenting of svc
    By superorozco in forum Cardiology
    Replies: 0
    Last Post: 03-30-2010, 01:25 PM
  5. Occluded SVC
    By SADLERJ in forum Cardiology
    Replies: 0
    Last Post: 07-08-2008, 10:59 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.