coffee2day
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Hello, any advice on how to code operative reports indicating aortic valve replacement with left ventricular outflow tract enlargement?
Many of these op reports indicate the aortic valve annulus is too small for the valve, so they are enlarging the annulus for size. I feel we should bill CPT 33411 aortic valve replacement with annulus enlargement.
But can someone explain if it is correct NOT to assign CPT 33414 repair of left ventricular outflow tract obstruction by patch enlargement of the outflow tract? CPT 33411 bundles with 33414. I'm trying to understand when we would use CPT 33414.
Example of op report with title aortic valve replacement with LVOT enlargement (to me this is annulus enlargement, lvot enlargement is part of this procedure, and doesn't represent CPT 33414) -
"the patient had small aortic root with aortic annulus approx. 20-21 mm, therefore I enlarged it with a patch and was able to get in a 25mm valve. Hemashield graft and sewed in a graft to it with a running 3-0 Prolene suture and a large annulus. I then placed a series of 2-0 Tevdek sutures transannular from the ventricular to aortic side. I irrigated the space copiously with saline. I sized the valve until a into a 25 mm valve. I placed the sutures through the valve and seated the valve into position. I tied the sutures. I then tailored the patch and closed the patch at the anterior aorta. "
Thank you.
Many of these op reports indicate the aortic valve annulus is too small for the valve, so they are enlarging the annulus for size. I feel we should bill CPT 33411 aortic valve replacement with annulus enlargement.
But can someone explain if it is correct NOT to assign CPT 33414 repair of left ventricular outflow tract obstruction by patch enlargement of the outflow tract? CPT 33411 bundles with 33414. I'm trying to understand when we would use CPT 33414.
Example of op report with title aortic valve replacement with LVOT enlargement (to me this is annulus enlargement, lvot enlargement is part of this procedure, and doesn't represent CPT 33414) -
"the patient had small aortic root with aortic annulus approx. 20-21 mm, therefore I enlarged it with a patch and was able to get in a 25mm valve. Hemashield graft and sewed in a graft to it with a running 3-0 Prolene suture and a large annulus. I then placed a series of 2-0 Tevdek sutures transannular from the ventricular to aortic side. I irrigated the space copiously with saline. I sized the valve until a into a 25 mm valve. I placed the sutures through the valve and seated the valve into position. I tied the sutures. I then tailored the patch and closed the patch at the anterior aorta. "
Thank you.
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