Results 1 to 9 of 9

Thread: Mitral Valve Repair

  1. #1

    Default Mitral Valve Repair

    Could someone please advise me if this scenario warrants being coded differently than a single Mitral repair using one prosthetic ring (33426)

    "Mitral valve repair using a double-decker approach with a #36 AnnuloFlex ring along the papillary muscles and a 28-mm MEMO3D ring at the annulus"

    Thanks for any adivce.

  2. #2

    Default

    I am looking into this...I have actually never seen a case where 2 rings were used. I'll get back to you

  3. #3

    Default

    I checked with a CT surgeon and he thinks it would be a "complex" repair, but I'm not sure that would mean a 33427 just because they used 2 rings. It could possibly warrant a 22 modifier on the 33426. But without seeing the rest of the report I can't tell for sure.

  4. #4

    Default Here is the report, Maybe I read into it wrong. MLS2 thank you for your help.

    OPERATION: Coronary artery bypass grafting x3 using the left
    internal mammary artery to the left anterior descending, saphenous
    vein graft to the diagonal, saphenous vein graft to the obtuse
    marginal and mitral valve repair using a double-decker approach with
    a #36 AnnuloFlex ring along the papillary muscles and a 28-mm MEMO3D
    ring at the annulus.

    ANESTHESIA: General endotracheal.

    INDICATIONS: Patient is a 49-year-old male who has presented with
    complaints of chest pain and severe shortness of breath. He
    decompensated over the weekend and was found to have severe mitral
    valve regurgitation. He had ruled in for myocardial infarction.
    His catheterization shows that he has very complex disease in the
    circumflex and left anterior descending distribution and he has an
    occluded right coronary artery. He has severe mitral regurgitation
    on the basis of restricted leaflet defect and posterior medial
    papillary muscle dysfunction. He is for surgical repair.

    PROCEDURE: The patient was taken to the operating room. He
    underwent a general endotracheal anesthetic. A Swan-Ganz catheter,
    radial artery catheter and transesophageal echocardiography probe
    were placed prior to beginning his operation. He was brought to the
    operating room and scrubbed and draped in the usual sterile fashion.
    A median sternotomy was made using our standard technique. The
    left internal mammary artery was harvested using electrocautery. It
    was a 3-mm vessel of good quality and harvested without any
    identifiable injury. A vein was harvested from the right thigh
    using the endoscopic vein harvesting system. The patient was
    anticoagulated. The ascending aorta was cannulated with a 20-French
    aortic cannula. The superior vena cava was cannulated with a
    28-French single-stage venous cannula. The inferior vena cava was
    cannulated with a 32-French single stage venous cannula. A
    retrograde cardioplegic cannula was placed in the coronary sinus.
    The antegrade cardioplegic cannula was placed in the ascending
    aorta. Cardiopulmonary bypass was instituted. The aorta was
    crossclamped and 1 liter of cardioplegia was given. Antegrade ice
    was used as a topical hypothermic agent. We then began our grafts.
    The proximal descending artery is nongraftable. It is a very small
    vessel. We grafted the first obtuse marginal. It is a 2-mm vessel
    of good quality. We sewed a vein graft to this using 7-0 Prolene in
    running technique and gave an additional 500 mL of cold blood. We
    then grafted the diagonal. It is a 1.75-mm vessel of good quality.
    We sewed a vein graft to this using 7-0 Prolene and gave an
    additional 500 mL of cold blood. We then snared the KV. We opened
    the right atrium and extended it through the roof of the left atrium
    and then sewed the anteroapical septum. We placed a 36-mm
    Carbomedics AnnuloFlex ring, which we weaved around the base of the
    papillary muscles and then sewed it back together with 4-0 Gore-Tex
    sutures. We then brought one end of the Gore-Tex sutures through
    the base of the papillary muscles and sewed it to the other side of
    the ring and tied it back down into position. This allowed us to
    pull the papillary muscles into a midline position. We had run
    retrograde cardioplegia at least every 20 minutes. We then placed a
    28-mm MEMO3D ring on our annulus. We brought our sutures through
    the annulus, brought them up to the ring and then tied it down into
    position. We then insufflated the ventricle copiously with saline
    and it appeared that we had a good result. We then closed our
    atriotomies with a 3-0 Prolene.
    We placed the left ventricular
    valve via the right superior pulmonary vein. We then grafted the
    left mammary to the left anterior descending. It is a 2-mm vessel
    of good quality. We sewed this using 7-0 Prolene. We then tacked
    it to the anterior surface of the left ventricle. We gave the hot
    shot cardioplegic solution. We released the aortic crossclamp and
    placed a side-biting clamp across the ascending aorta. A 4.4-mm
    punch was used for the aortotomies and then both vein grafts were
    sewn directly to the aorta using 5-0 Prolene. We released the
    side-biting clamp, deaired the grafts and allowed them to reperfuse.
    We resumed ventilation. We deaired the left ventricle. We weaned
    the patient from cardiopulmonary bypass without difficulty. His
    postoperative echocardiogram shows good biventricular function with
    an ejection fraction of about 50%. We reversed our anticoagulation
    with protamine, decannulated the patient and placed a pacer wire in
    the inferior surface of the right ventricle and one onto the skin.
    We placed a chest tube into each thorax. He had large bilateral
    effusions. We drained about 2 liters of the pleural effusions. We
    closed the pericardium and placed a chest tube into the mediastinum.
    The sternum was closed with #6 stainless steel wire. The
    subcutaneous layers were closed with two layers of 0 Polysorb. The
    skin was closed with 3-0 Polysorb. The patient was transferred to
    the intensive care unit in stable condition.

  5. #5

    Default

    I came up with 33533-51, 33518, 33508 and for this one I think I would go with the 33427.

    hope this helps!

  6. #6

    Default

    Thank you for being so helpful

  7. #7

    Red face Slg

    My reply may be a bit late, but I wanted to offer my thoughts. After reading the note, I do not feel that this procedure was "complex" or "radical". You can have a complex or radical repair without a "ring". What I would suggest, depending upon the payer, is to bill the 33426 with a 22 modifier. The extra work involved in the repair was an additional ring. He/She did not transfer chords for this pt, or do anything extensive outside the scope of sewing 2 rings in place. It probably took more time and was a bit more tedious, but it does not look radical to me. I would be interested in knowing how you bill this and if the claim was paid or denied.

  8. #8

    Default

    Sgochoco- I was going to bill with 33427. But in the end I felt more comfortable with the 33425-22, and so that was what I billed for.

    I tell ya, this coding business can really make you think. In cases like these, I put the report to the side... and re-read the next day.

    Thanks for your input!

  9. #9

    Default

    Should have went with my gut instinct...that's what I thought at first
    glad you figured it out.

Similar Threads

  1. Mitral Valve Repair
    By slc112071 in forum Cardiovascular Thoracic
    Replies: 1
    Last Post: 03-21-2013, 10:28 AM
  2. Mitral Valve repair w/Ring
    By nyyankees in forum Cardiovascular Thoracic
    Replies: 3
    Last Post: 02-26-2013, 11:12 AM
  3. Minimally invasive mitral valve repair
    By sandy06 in forum Cardiovascular Thoracic
    Replies: 2
    Last Post: 05-21-2012, 08:25 AM
  4. Mitral Valve repair question...
    By krisfelty in forum Cardiovascular Thoracic
    Replies: 1
    Last Post: 04-09-2011, 02:06 PM
  5. Transaortic mitral valve repair
    By cllothes in forum Cardiovascular Thoracic
    Replies: 1
    Last Post: 08-20-2010, 02:35 PM

Posting Permissions

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