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Thread: Attempted AVR

  1. #1

    Default Attempted AVR

    AAPC: Back to School
    Name of Procedure: Exploratory median sternotomy in an attempt to perform aortic valve replacement.

    ....a median sternotomy was performed the same time that the endovascular equipment was inserted in the right lower extremity. The mediastinum was dissected. The pericardium was incised and marsupialized. Once we had exposed the ascending aorta on the heart, we noticed that the aorta was very calcified. We checked the extent of this calcification and noticed tht it was unsafe to cannulate this patient. In order to continue with the standard AVR, the patient will require peripheral cannulation and hypothermic circulartory arrest to also replace the ascending aorta. In view of this fragile clinical condition, we made the decision of not proceeding with the AVR and to abort the open heart procedure.

    I wasn't sure whether I should bill the 33405-53 or should I bill with a sternotomy code. My gut feeling tells me the 33405-53. Any input would be appreciated!

  2. #2



    I think I agree with 33405-53. I believe you're supposed to keep the primary diagnosis the same (whatever it was going to be for the AVR - ie: 424.1) and then add the extenuating circumstance as the 2nd dx., which in this case would be 440.0.

    Lisi, CPC

  3. #3


    I would have forgotten about the 440.0 code....thanks for your help!

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