# Help please! New to Cardio Coding!



## serhaug (Sep 7, 2012)

What would you use to code a "septation of the heart with needing a fenestration at the atrial level"? This was for an unbalanced AV canal, left dominant variety and inadequat right ventricular capacity. The procedures were terminated after the pt was on bypass, so I know it would be mod. 53 but the actual procedures are a little fuzzy for me. Thanks!


----------



## hewitt (Sep 7, 2012)

Probably would be best to post the op note.


----------



## serhaug (Sep 7, 2012)

How do I do that? (sorry  )


----------



## hewitt (Sep 7, 2012)

If an electronic record, you may be able to copy and paste. If not, then maybe type in the section describing what was done. Does not have to be the entire note.


----------



## serhaug (Sep 7, 2012)

We had an extensive discussion w/ the family about the potential risks associated with this procedure and elected to go forward with an effort to carry out a septation of the heart with needing a fenestration at the atrial level.

Description of Op Procedure: Pt was brought to OR and placed on the operating tale in the supine position. After induction of anesthesia and placement of lines the patient was positioned, prepped and draped in the usual manner. Median sternotomy was carried out, followed by subtotal thymectomy. The pericardium was opened longitudinally and stay sutures were placed. the superior margin of the main pulmonary artery was dissected free and a ligamentum/patent ducturs arteriosus was ligated. Heparin was administered and aaortobicaval cannulation was completed with a 10 French arterial cannula and two 16 French venous cannulas. Cardiopulmonary bypass was intiated and the pt was cooled to 28 degrees centigrade. The aorta was crossclamped and cold blood cardioplegia was given in an antegrade fashion to arrest the heart. Additional doses of cardioplegia were given at 15 minute intervals through the remainder of the crossclamp. A vent was inserted in the right superior pulmonary vein. The caval snares were secured and the right atrium was opened and an extensive inspection of the AV canal defect was carried out and identified the following:
1. Minimal cavitary volume of the right ventricle limited only to the outflow infundibular portion. 2. Hypoplastic tricuspid valve with significant tricuspid valve stenosis with a tricuspid valve orifice measuring no more than 6 mm in diameter. 3 Markedly dysplastic elements of the common leaflet. 4. Normal-appearing pulmonary valve. 

There findings were obtained by looking through the right atrium and opening the main pulmonary artery and looking down through the pulmonary valve into the right ventricle. In short, there was no way to carry out septation of this heart without winding up with a markedly hypoplastic right ventricle in terms of volume and a markedly diminutive tricuspid valve. We considered all of the other options and in the light of the cath data which suggested the presence of significantly elevated pulmonary vascular resistance, we determined that the best course of action for the overall survival of this patient was to terminate the procedure.  

(then they closed stuff up and the following times were given: aortic cross clamp time 39 mins, cardiopulmonary bypass time 112 mins)


Thanks for helping. I'm stuck.....


----------



## hewitt (Sep 7, 2012)

Wow! This is amazing! I have not seen this before, but is this for an infant? Anyway, I cannot tell for sure, but it looks to me that CPTs 33600-33697 would apply.... Maybe 33610, 33615, 33622, 33641? Just curious, but what diagnosis has the doctor assigned?


----------



## serhaug (Sep 7, 2012)

He assigned 93799! I KNOW that isn't right! This is an infant, yes. A 5-month-old.


----------



## hewitt (Sep 7, 2012)

Is it possible for you to ask the doctor if 33641 or the others are what he intended to do?


----------



## serhaug (Sep 7, 2012)

oh my gosh, you were asking for diagnosis. Good gravy, I read CPT. The dx is Down's syndrome w/ unbalanced AV canal (hypoplastic right ventricle). Sorry!


----------



## serhaug (Sep 7, 2012)

Unfortunately, no, I'm unable to ask the doctor. He is no longer available for consult.


----------



## serhaug (Sep 7, 2012)

I'm just auditing another coder's work and they wanted to assign 93799 and I'm 100% positive that is not correct.


----------



## hewitt (Sep 10, 2012)

Unfortunately, I spent as much time as I have on locating the grouping of possible CPTs. The diagnoses are easier to code, but because you cannot query the provider, it may be best to leave the CPT as is and send the operative note with the Claim Form to the insurance carrier.


----------

