Wiki Mediastinal exploration - the correct code

[dpumford]

Hello: I have a pt who had a AVR & AAA repair. The patient also had a IABP put in for cardiogenic shock. Patient was brought back in to the OR one week later for IABP removal and exploration w/sternal closure.

My concern is that the chest exploratin (35820) is not the correct code.

The previous sutures were cut and removed. Wound was again cleaned and skin was opened. the strut and suture holding the sternum together were removed. We opend the sternum with retractor and placed retention sutures on the pericardium on the rt side. This allowed exposure of the rt atrium and ultimately the rt sup pulmonary vein which was the entry site for the lt atrial line. Line was pulled. The pursestrig secured the entry site. Hemostasis was secured. We irrigated with bet solution cleaned all 3 of previous chest tubes and replaced them. Then we proceeded to close with #5 wire, placing a figure-of-eight stitch across the previous transected portion of sternum. Sternum was brought together with no hemodynamic consequences.

Any advice would be appreciated. I was thinking this is more of a 21750, Closure.

Thank you!

 

[lisigirl]

I'm not sure I like either code. I agree that 35820 is not appropriate. That code should be used for chest exploration when there is an infection, bleeding or thrombosis.

As far as 21750 goes, I usually code this for one of two scenarios:
1. when there is sternal dehiscence or
2. if the sternum has been left open for a couple days post-op and the surgeon brings the patient back to close (I add -58 in this case).

In this case, the sternotomy was not coming apart and the chest was not left open, your surgeon actually re-opened the chest to remove the IABP.

What about code 33974 for the removal of the IABP? (this would include the sternal closure).

Lisi, CPC