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Help with hemi aortic arch repair

  1. Default Help with hemi aortic arch repair
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    I'm not sure what code is appropriate for this hemi arch repair for aneurysm. Here are the pertinent details.

    Pt. is status post repair of a type A aortic dissection, some time ago. Pt. had a residual type B aortic dissection with aneurysmal arch, the dissection only went to the proximal aorta. Pt. has been followed with CT's and now show progression of the size of the aneurysmal component. Left thoracotomy was performed. Obvious aneurysmal dilatation of the distal aortic arch was noted. Aortic arch was visible from the left chest as was the innominate artery, left subclavian and left common carotid. The arch is opened. A Hemashield graft with a 10mm chimney is chosen and sutured into the aortic arch. A teflon felt buttress was utiilized for the cephalad portion of this repair. The aorta was opened distally to an area that was consistent with the end of the dissection at the proximal descending aorta. The graft was then fashioned and sutured to the aorta distally in this location.

    It is the bottom of the arch - hemi arch, that is where the aneurysm is and dissection extends to the proximal descending aorta. I am looking at code 33870, but he does not have to remove the vessels at the top of the arch, all the work is at the bottom. No valve work is done. Just not sure if 33870 is correct or should I use 33875 as the dissection is just to the descending aorta. Or should it be 33870 with a 52 modifier. I have actually coded in the past 33870 exactly as described in the CDR, but this one is different. Any help would be greatly appreciated.

  2. #2
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    Quote Originally Posted by hencked View Post
    I'm not sure what code is appropriate for this hemi arch repair for aneurysm. Here are the pertinent details.

    Pt. is status post repair of a type A aortic dissection, some time ago. Pt. had a residual type B aortic dissection with aneurysmal arch, the dissection only went to the proximal aorta. Pt. has been followed with CT's and now show progression of the size of the aneurysmal component. Left thoracotomy was performed. Obvious aneurysmal dilatation of the distal aortic arch was noted. Aortic arch was visible from the left chest as was the innominate artery, left subclavian and left common carotid. The arch is opened. A Hemashield graft with a 10mm chimney is chosen and sutured into the aortic arch. A teflon felt buttress was utiilized for the cephalad portion of this repair. The aorta was opened distally to an area that was consistent with the end of the dissection at the proximal descending aorta. The graft was then fashioned and sutured to the aorta distally in this location.

    It is the bottom of the arch - hemi arch, that is where the aneurysm is and dissection extends to the proximal descending aorta. I am looking at code 33870, but he does not have to remove the vessels at the top of the arch, all the work is at the bottom. No valve work is done. Just not sure if 33870 is correct or should I use 33875 as the dissection is just to the descending aorta. Or should it be 33870 with a 52 modifier. I have actually coded in the past 33870 exactly as described in the CDR, but this one is different. Any help would be greatly appreciated.
    I'm thinking you should use the 33875. I say that because of STS's direction on this matter, if my interpretation is correct. See below:

    "STS says that you should only bill 33870, "if direct anastomosis of graft to the descending aorta with a side of graft to end of head vessel island (including the grafting or re-implantation of the brachiocephalic, left common carotid and left subclavian arteries) anastomosis is performed. It would not be appropriate to report this code when only the lesser curve of the arch is done. You should not bill for the transverse arch (elephant trunk procedure) if the head vessels are not touched. Code 33870 should not be coded if hemi-arch is performed."
    Julie Graham, BA, CPC, CCC

  3. Smile thanks - hemi arch info
    Thanks, that helps me a lot. I just wasn't comfortable with 33870. But didn't know which was the appropriate way to code. I code quite a few different specialties and feel at times I am not versed enough to figure out the coding rules in some of these cases that are very complicated.

    Thanks,

    Deb H.
    CPC

  4. #4
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    Quote Originally Posted by hencked View Post
    Thanks, that helps me a lot. I just wasn't comfortable with 33870. But didn't know which was the appropriate way to code. I code quite a few different specialties and feel at times I am not versed enough to figure out the coding rules in some of these cases that are very complicated.

    Thanks,

    Deb H.
    CPC
    I hear you! I've been coding Cardio three years but CT only about 1 year. Still so much to learn! I feel that same way at times. I read some of the stuff on here and just can't answer it. I think the Thoracic Aortic Aneurysm procedures can be tricky and the wording still has a tendency to trip me up. My boss is going to the STS conference, I'm so jealous but I started after they budgeted who would go
    Julie Graham, BA, CPC, CCC

  5. Default
    I actually have to disagree. I think I would bill 33870-52. I am the first one to tell you that you can't use 33870 for a hemiarch but I don't think you have a choice here. The graft stopped proximal to the descending aorta so it did not include this, therefore, I think 33875 would be inappropriate.

    Lisi,CPC
    eharkler@nmh.org

  6. #6
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    Quote Originally Posted by lisigirl View Post
    I actually have to disagree. I think I would bill 33870-52. I am the first one to tell you that you can't use 33870 for a hemiarch but I don't think you have a choice here. The graft stopped proximal to the descending aorta so it did not include this, therefore, I think 33875 would be inappropriate.

    Lisi,CPC
    eharkler@nmh.org
    Ah I see what you're saying. It can't be the 33875 because technically the graft did not include the descending aorta since it stopped proximal to it. Is there a site where you can see a picture or pictures to have a better understand of where the doc is at when doing these? Thanks lisi!
    Julie Graham, BA, CPC, CCC

  7. Talking
    Thanks for the update. It had crossed my mind about 33870 with a 52. I understand about the dissection stopping at the descending. Appreciate the help!

    Deb H.

  8. Default
    No problem. I've been lucky enough to attend the STS coding workshop every year for the last 6 yrs so I think I have a pretty good handle on this stuff

    Lisi, CPC

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