mush69
Contributor
Would I use 33780 for this?
If someone could please look at this report and let me know if I am right, I think I should code 33780. I just started coding congenital and I am still a little confused.
Thanks
OPERATION:
1. ARTERIAL SWITCH.
2. CLOSURE OF VENTRICULAR SEPTAL DEFECT.
3. RECONSTRUCTION OF ATRIAL SEPTUM.
4. ECMO SUPPORT.
INDICATIONS: is a newborn with D-transposition of the great vessels
and ventricular septal defect underwent balloon atrial septostomy soon after
birth. She is being taken to the Operating Room electively for
intervention.
FINDINGS: Moderate size ventricular septal defect was identified and closed
with a Sauvage patch. The atrial septum was reconstructed primarily. The
coronary anatomy consisted of a dominant left-sided circulation with the
posterior descending artery coming off the left-sided circulation. A small
right coronary artery came off a separate orifice. The arterial switch was
performed with a LeCompte maneuver. Near the end of the procedure, when the
aortic cross-clamp was removed, the left ventricle became acutely distended.
This was not initially appreciated. When the patient was read to separate
from bypass, there was global left ventricular dysfunction with excellent
right ventricular function and mild aortic insufficiency. We therefore made
the decision to proceed with biatrial venous cannulation for venoarterial
ECMO to completely rest the heart. The aortic cross-clamp time was 130
minutes. Cardiopulmonary bypass time 378 minutes.
TECHNICAL DESCRIPTION: The patient was brought to the Operating Room and
placed on the table in the supine position. Following the induction of
general endotracheal anesthesia, arterial and central venous lines were
inserted and secured. The entire chest, abdomen and groins were prepped and
draped in a routine sterile fashion. A median sternotomy was performed.
The skin was incised with a scalpel and the soft tissue was divided with
electrocautery down to the level of the sternum. The sternum was then
opened with scissors. The thymus was excised. The pericardium was
harvested anteriorly and the remainder was suspended. The patient was
systemically anticoagulated with heparin. Prior to this time, it should be
noted that the branch pulmonary arteries were widely mobilized and the
coronary artery was identified and marked for coronary artery transfer. A
pursestring was placed in the distal ascending aorta and aortic cannula was
inserted and secured. Venous cannulas were placed individually into the
superior and inferior vena cava and secured. The patient was then placed on
cardiopulmonary bypass. The heart was rested using cardiopulmonary bypass
and the ductus was ligated and divided. The right atrium was then entered
and the VSD was identified. A Sauvage patch was appropriately fashioned and
sewn in place with a running 6-0 Prolene with reinforcement along the base
of the septal leaflet of the tricuspid valve. Following an additional dose
of cardioplegia, the great vessels were divided and the LeCompte maneuver
was performed bringing the branch pulmonary arteries anterior to the aorta.
The neo-aorta was then reconstructed. The coronary arteries were harvested
as buttons with the left main and right coronary artery. The cross-clamp
was then temporarily removed and appropriate site for the left main coronary
implantation was identified and a small ellipse of aorta was removed and the
cross-clamp was reapplied. The left main coronary artery was sewn in place
with a running 7-0 Prolene suture. The clamp was then transiently removed
and the site for the right coronary artery was incised. Additional
cardioplegia was administered following reapplication of the aortic
crossclamp. The right coronary artery was then sewn in place with a running
7-0 Prolene suture. The intra-atrial septum was then reconstructed with a
running 6-0 Prolene suture. The left side of the heart was deaired and with
the patient in a steep Trendelenburg position, the aortic cross-clamp was
again removed. While closing the right atriotomy with a running 6-0
Prolene, the left ventricle was intermittently distended and was
decompressed. Atrial and ventricular pacing was then placed on the heart
and the heart was gradually warmed. Milrinone was loaded and initial
attempt was made to separate from cardiopulmonary bypass. The left
ventricle was globally dysfunctional with excellent right ventricular
function consistent with a left ventricular stun. The left coronary
arteries were again examined. There was felt to be excellent flow with the
stented coronary arteries. This was felt to be a cardiac stun. I therefore
decided to proceed with ECMO. A pursestring was placed around the left
atrial appendage and a 10 French venous cannula was placed through left
atrial appendage and across the mitral valve into the left ventricle. An
additional bullet-tip cannula was placed through a pursestring in the right
atrial appendage and secured. An additional pursestring was placed at the
base of the innominate artery and an 8 French arterial cannula was inserted
and secured. These cannulas were all attached to the ECMO circuit and full
ECMO support was initiated. This allowed discontinuation of the
cardiopulmonary bypass circuit and the old cannulas were removed and
hemostasis was obtained. Additional thrombin, Gelfoam and Evicel were used
to improve hemostasis around the aortic and pulmonary reconstructions.
Mediastinal pleural drains were inserted. A sternal stent was inserted in
the upper mediastinum and the cannulas were all secured to the sternum. The
skin was then cleaned and Benzoin and an Ioban seal were placed over the
chest. The baby remained on ECMO and was taken to the Pediatric Intensive
Care Unit.
If someone could please look at this report and let me know if I am right, I think I should code 33780. I just started coding congenital and I am still a little confused.
Thanks
OPERATION:
1. ARTERIAL SWITCH.
2. CLOSURE OF VENTRICULAR SEPTAL DEFECT.
3. RECONSTRUCTION OF ATRIAL SEPTUM.
4. ECMO SUPPORT.
INDICATIONS: is a newborn with D-transposition of the great vessels
and ventricular septal defect underwent balloon atrial septostomy soon after
birth. She is being taken to the Operating Room electively for
intervention.
FINDINGS: Moderate size ventricular septal defect was identified and closed
with a Sauvage patch. The atrial septum was reconstructed primarily. The
coronary anatomy consisted of a dominant left-sided circulation with the
posterior descending artery coming off the left-sided circulation. A small
right coronary artery came off a separate orifice. The arterial switch was
performed with a LeCompte maneuver. Near the end of the procedure, when the
aortic cross-clamp was removed, the left ventricle became acutely distended.
This was not initially appreciated. When the patient was read to separate
from bypass, there was global left ventricular dysfunction with excellent
right ventricular function and mild aortic insufficiency. We therefore made
the decision to proceed with biatrial venous cannulation for venoarterial
ECMO to completely rest the heart. The aortic cross-clamp time was 130
minutes. Cardiopulmonary bypass time 378 minutes.
TECHNICAL DESCRIPTION: The patient was brought to the Operating Room and
placed on the table in the supine position. Following the induction of
general endotracheal anesthesia, arterial and central venous lines were
inserted and secured. The entire chest, abdomen and groins were prepped and
draped in a routine sterile fashion. A median sternotomy was performed.
The skin was incised with a scalpel and the soft tissue was divided with
electrocautery down to the level of the sternum. The sternum was then
opened with scissors. The thymus was excised. The pericardium was
harvested anteriorly and the remainder was suspended. The patient was
systemically anticoagulated with heparin. Prior to this time, it should be
noted that the branch pulmonary arteries were widely mobilized and the
coronary artery was identified and marked for coronary artery transfer. A
pursestring was placed in the distal ascending aorta and aortic cannula was
inserted and secured. Venous cannulas were placed individually into the
superior and inferior vena cava and secured. The patient was then placed on
cardiopulmonary bypass. The heart was rested using cardiopulmonary bypass
and the ductus was ligated and divided. The right atrium was then entered
and the VSD was identified. A Sauvage patch was appropriately fashioned and
sewn in place with a running 6-0 Prolene with reinforcement along the base
of the septal leaflet of the tricuspid valve. Following an additional dose
of cardioplegia, the great vessels were divided and the LeCompte maneuver
was performed bringing the branch pulmonary arteries anterior to the aorta.
The neo-aorta was then reconstructed. The coronary arteries were harvested
as buttons with the left main and right coronary artery. The cross-clamp
was then temporarily removed and appropriate site for the left main coronary
implantation was identified and a small ellipse of aorta was removed and the
cross-clamp was reapplied. The left main coronary artery was sewn in place
with a running 7-0 Prolene suture. The clamp was then transiently removed
and the site for the right coronary artery was incised. Additional
cardioplegia was administered following reapplication of the aortic
crossclamp. The right coronary artery was then sewn in place with a running
7-0 Prolene suture. The intra-atrial septum was then reconstructed with a
running 6-0 Prolene suture. The left side of the heart was deaired and with
the patient in a steep Trendelenburg position, the aortic cross-clamp was
again removed. While closing the right atriotomy with a running 6-0
Prolene, the left ventricle was intermittently distended and was
decompressed. Atrial and ventricular pacing was then placed on the heart
and the heart was gradually warmed. Milrinone was loaded and initial
attempt was made to separate from cardiopulmonary bypass. The left
ventricle was globally dysfunctional with excellent right ventricular
function consistent with a left ventricular stun. The left coronary
arteries were again examined. There was felt to be excellent flow with the
stented coronary arteries. This was felt to be a cardiac stun. I therefore
decided to proceed with ECMO. A pursestring was placed around the left
atrial appendage and a 10 French venous cannula was placed through left
atrial appendage and across the mitral valve into the left ventricle. An
additional bullet-tip cannula was placed through a pursestring in the right
atrial appendage and secured. An additional pursestring was placed at the
base of the innominate artery and an 8 French arterial cannula was inserted
and secured. These cannulas were all attached to the ECMO circuit and full
ECMO support was initiated. This allowed discontinuation of the
cardiopulmonary bypass circuit and the old cannulas were removed and
hemostasis was obtained. Additional thrombin, Gelfoam and Evicel were used
to improve hemostasis around the aortic and pulmonary reconstructions.
Mediastinal pleural drains were inserted. A sternal stent was inserted in
the upper mediastinum and the cannulas were all secured to the sternum. The
skin was then cleaned and Benzoin and an Ioban seal were placed over the
chest. The baby remained on ECMO and was taken to the Pediatric Intensive
Care Unit.
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