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Tricuspid Valve

  1. Default Tricuspid Valve
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    I hope this is a simple question.....would we code for the tricuspid valve exploration and if yes, what would you code? Thanks so much :-)

    PREOPERATIVE DIAGNOSES:
    1. Prosthetic mitral valve stenosis.
    2. Tricuspid regurgitation.

    POSTOPERATIVE DIAGNOSES:
    1. Prosthetic mitral valve stenosis.
    2. Tricuspid regurgitation.

    OPERATIVE PROCEDURE: Redo cardiac surgery with mitral valve replacement
    using a 29 mm Medtronic Hancock II porcine valve and inspection of the
    tricuspid valve.

    FINDINGS: This patient had an Edwards pericardial mitral valve put in about
    8 years ago. Now the mitral valve was completely calcified and became
    stenotic. The patient also had tricuspid valve repair before. Although the
    tricuspid valve repair appears to be fairly good, there is some central
    regurgitation, which I felt could not be corrected and may be this is from
    pulmonary hypertension.

    DESCRIPTION OF PROCEDURE: Under general endotracheal anesthesia,
    cardiopulmonary bypass was instituted through a repeat median sternotomy
    incision. All the extensive adhesions had to be carefully lysed to get
    exposure of the cannulation as well as for the mitral valve exposure. After
    aortic cannula for arterial inflow and bicaval cannula for the venous outflow
    was used, antegrade and retrograde blood cardioplegic solution was given.
    After going on bypass and a resting heart, first left atrium was opened
    behind the intraatrial groove and mitral valve was exposed. Mitral valve was
    removed, the prosthesis was removed. I was able to implant a 29 mm Hancock
    II porcine valve in the supra-annular position with pledgeted sutures on the
    ventricular side. Then the atriotomy was closed. The right atrium was
    opened and tricuspid valve was inspected. There is some central
    regurgitation but the annuloplasty appears to be fairly good. So right
    atriotomy was closed, heart was de-aired, and aortic cross-clamp was
    released. After coming off cardiopulmonary bypass, all the cannulas were
    removed. Sites were ligated. Hemostasis was secured. Protamine was given
    to neutralize the effect of heparin, and sternotomy wound was closed back in
    layers.

    Antibiotics were given within 1 hour of prescribed skin incision time.
    Platelet-rich plasma was used to promote sternal wound healing. Vancomycin
    paste was applied to the sternal edges to prevent sternal wound infection. I
    had stayed and performed the entire operative procedure.

  2. #2
    Location
    Richardson, TX
    Posts
    822
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    Quote Originally Posted by conleyclan View Post
    I hope this is a simple question.....would we code for the tricuspid valve exploration and if yes, what would you code? Thanks so much :-)

    PREOPERATIVE DIAGNOSES:
    1. Prosthetic mitral valve stenosis.
    2. Tricuspid regurgitation.

    POSTOPERATIVE DIAGNOSES:
    1. Prosthetic mitral valve stenosis.
    2. Tricuspid regurgitation.

    OPERATIVE PROCEDURE: Redo cardiac surgery with mitral valve replacement
    using a 29 mm Medtronic Hancock II porcine valve and inspection of the
    tricuspid valve.

    FINDINGS: This patient had an Edwards pericardial mitral valve put in about
    8 years ago. Now the mitral valve was completely calcified and became
    stenotic. The patient also had tricuspid valve repair before. Although the
    tricuspid valve repair appears to be fairly good, there is some central
    regurgitation, which I felt could not be corrected and may be this is from
    pulmonary hypertension.

    DESCRIPTION OF PROCEDURE: Under general endotracheal anesthesia,
    cardiopulmonary bypass was instituted through a repeat median sternotomy
    incision. All the extensive adhesions had to be carefully lysed to get
    exposure of the cannulation as well as for the mitral valve exposure. After
    aortic cannula for arterial inflow and bicaval cannula for the venous outflow
    was used, antegrade and retrograde blood cardioplegic solution was given.
    After going on bypass and a resting heart, first left atrium was opened
    behind the intraatrial groove and mitral valve was exposed. Mitral valve was
    removed, the prosthesis was removed. I was able to implant a 29 mm Hancock
    II porcine valve in the supra-annular position with pledgeted sutures on the
    ventricular side. Then the atriotomy was closed. The right atrium was
    opened and tricuspid valve was inspected. There is some central
    regurgitation but the annuloplasty appears to be fairly good. So right
    atriotomy was closed, heart was de-aired, and aortic cross-clamp was
    released. After coming off cardiopulmonary bypass, all the cannulas were
    removed. Sites were ligated. Hemostasis was secured. Protamine was given
    to neutralize the effect of heparin, and sternotomy wound was closed back in
    layers.

    Antibiotics were given within 1 hour of prescribed skin incision time.
    Platelet-rich plasma was used to promote sternal wound healing. Vancomycin
    paste was applied to the sternal edges to prevent sternal wound infection. I
    had stayed and performed the entire operative procedure.

    I wouldn't. He was already in the heart just opened the right atrium took a quick look and closed it back up. If you or the physician wanted to capture that work then maybe you could use 33310/33315 but that's probably a stretch.
    Julie Graham, BA, CPC, CCC

  3. #3
    Default
    I, too, looked at using the 33310 code to describe the work done by opening/exploring the right atrium but a more in-depth code description of 33310 by EncoderPro says, "....these codes should not be reported for exploration related to congential anomalies or disease of heart structures." If the surgeon were to further identify the time spent in both providing the annuloplasty exploration and in the removal of the extensive adhesions he/she encountered on opening the sternum, a 22 modifier might be in order. Hope this helps!

    V Davis CPC CGIC

  4. Default
    Thank you so so much!!!

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