klthompson
Contributor
I used a unlisted procedure code for the following op note and the insurance denied stating a more appropriate code was available. I am unsure what code they are saying is appropriate. Any help would be appreciated.
NAME OF OPERATION
1. Mitral valve repair.
2. Placement of a #25 St. Jude ring.
DESCRIPTION OF OPERATION
The patient was a 68-year-old female who was taken to the Operating Room, and placed in the reclining position, and induced under general endotracheal anesthesia. Chest and lower extremities were sterilely prepped with Betadine and draped in the usual fashion. We performed a transesophageal echocardiogram following induction of general anesthesia, which demonstrated a central regurgitant element. There was no significant prolapse of the anterior posterior leaflet of the mitral valve. We opened the sternum in the midline. The aorta was cannulated with an 8-mm short-nosed aortic cannula. The right atrium was cannulated with 2 venous cannulas, #28 French in the superior and inferior vena cava respectively. The patient was placed on cardiopulmonary bypass and cooled to 30 degrees. The ascending aorta was cross-clamped. The heart received a total of 1 liter of cold blood antegrade cardioplegia. Retrograde cardioplegia cannula was placed in the coronary sinus. We gave cold continuous retrograde cardioplegia throughout the case. We placed a vent in the right superior pulmonary vein. We opened the left atrium. We inspected the mitral valve which was completely intact. There was no ruptured chordae. I performed an annuloplasty. I placed 2 Ethibond sutures circumferentially around the annulus. We sized the anterior ring which was consistent with a 25 St. Jude valve. We performed an annuloplasty suturing the flexible ring in place. We then closed the left atrium with a running 4-0 Prolene. We de-aired the heart through the apex of the left ventricle as well as aortic root. We re-warmed to 37 degrees. The cross-clamp was released. We weaned from bypass to cannulate. Protamine was administered. Chest tubes were placed in the mediastinum. Two ventricular pacing wires were placed. I thoroughly inspected for hemostasis. The sternum was closed with five 5-0 stainless steel wires in a figure-of-8 fashion. The fascia was closed with running 2-0 Prolene, skin was approximated with skin staples.
FINAL PROCEDURE
Mitral valve repair, placement of a #25 St. Jude annuloplasty ring.
NAME OF OPERATION
1. Mitral valve repair.
2. Placement of a #25 St. Jude ring.
DESCRIPTION OF OPERATION
The patient was a 68-year-old female who was taken to the Operating Room, and placed in the reclining position, and induced under general endotracheal anesthesia. Chest and lower extremities were sterilely prepped with Betadine and draped in the usual fashion. We performed a transesophageal echocardiogram following induction of general anesthesia, which demonstrated a central regurgitant element. There was no significant prolapse of the anterior posterior leaflet of the mitral valve. We opened the sternum in the midline. The aorta was cannulated with an 8-mm short-nosed aortic cannula. The right atrium was cannulated with 2 venous cannulas, #28 French in the superior and inferior vena cava respectively. The patient was placed on cardiopulmonary bypass and cooled to 30 degrees. The ascending aorta was cross-clamped. The heart received a total of 1 liter of cold blood antegrade cardioplegia. Retrograde cardioplegia cannula was placed in the coronary sinus. We gave cold continuous retrograde cardioplegia throughout the case. We placed a vent in the right superior pulmonary vein. We opened the left atrium. We inspected the mitral valve which was completely intact. There was no ruptured chordae. I performed an annuloplasty. I placed 2 Ethibond sutures circumferentially around the annulus. We sized the anterior ring which was consistent with a 25 St. Jude valve. We performed an annuloplasty suturing the flexible ring in place. We then closed the left atrium with a running 4-0 Prolene. We de-aired the heart through the apex of the left ventricle as well as aortic root. We re-warmed to 37 degrees. The cross-clamp was released. We weaned from bypass to cannulate. Protamine was administered. Chest tubes were placed in the mediastinum. Two ventricular pacing wires were placed. I thoroughly inspected for hemostasis. The sternum was closed with five 5-0 stainless steel wires in a figure-of-8 fashion. The fascia was closed with running 2-0 Prolene, skin was approximated with skin staples.
FINAL PROCEDURE
Mitral valve repair, placement of a #25 St. Jude annuloplasty ring.