Jess122808
New
Hi,
Im having trouble deciphering between 0483T vs 33418 for the below note. I think my confusion is that the procedure states replacement so i lean towards 0438T instead of 33418 which states repair.
Postop DX: Severe prosthetic mitral valve regurgitation, severe perivalvular prosthetic mitral valve leak
Procedure: Transcatheter valve in valve mitral valve replacement with a 26 mm Sapien 3 pericardial tissue valve
Indications: severe, prosthetic mitral valve regurgitation with a severe perivalvular leak.
Procedure
The patient was taken to the operating room and identified who performed an Amplatz closure of the perivalvular leak. When this was completed I joined the operation for the valve in valve in valve replacement.
Through the right femoral vein a transcutaneous pacemaker was placed and directed into the right ventricle. Correct operation was verified and stored. The patient was previously heparinized during the Amplatz procedure and ACT greater room 300 seconds was maintained. A catheter was placed through the right femoral vein and under fluoroscopic and transesophageal echo guidance the septum was crossed using a wire. Using a avalas steerable catheter a guide wire was positioned across the prosthetic mitral valve. A balloon dilatation was then done under fluoroscopic guidance. A 26 mm Sapien 3 valve was prepared on the back table using manufacture recommendations. The valve was then directed under fluoroscopic guidance across the atrial septum and positioned across the prosthetic mitral valve sewing ring. Once we were satisfied with positioning the patient was rapidly ventricular paced and the valve was deployed without incident. A transesophageal echo performed after the deployment demonstrated no residual perivalvular leak or mitral insufficiency. The catheter system was withdrawn and this portion of the operation was completed.
Any help would be greatly appreciated! Thanks!
Im having trouble deciphering between 0483T vs 33418 for the below note. I think my confusion is that the procedure states replacement so i lean towards 0438T instead of 33418 which states repair.
Postop DX: Severe prosthetic mitral valve regurgitation, severe perivalvular prosthetic mitral valve leak
Procedure: Transcatheter valve in valve mitral valve replacement with a 26 mm Sapien 3 pericardial tissue valve
Indications: severe, prosthetic mitral valve regurgitation with a severe perivalvular leak.
Procedure
The patient was taken to the operating room and identified who performed an Amplatz closure of the perivalvular leak. When this was completed I joined the operation for the valve in valve in valve replacement.
Through the right femoral vein a transcutaneous pacemaker was placed and directed into the right ventricle. Correct operation was verified and stored. The patient was previously heparinized during the Amplatz procedure and ACT greater room 300 seconds was maintained. A catheter was placed through the right femoral vein and under fluoroscopic and transesophageal echo guidance the septum was crossed using a wire. Using a avalas steerable catheter a guide wire was positioned across the prosthetic mitral valve. A balloon dilatation was then done under fluoroscopic guidance. A 26 mm Sapien 3 valve was prepared on the back table using manufacture recommendations. The valve was then directed under fluoroscopic guidance across the atrial septum and positioned across the prosthetic mitral valve sewing ring. Once we were satisfied with positioning the patient was rapidly ventricular paced and the valve was deployed without incident. A transesophageal echo performed after the deployment demonstrated no residual perivalvular leak or mitral insufficiency. The catheter system was withdrawn and this portion of the operation was completed.
Any help would be greatly appreciated! Thanks!
