Wiki Need help with a code

[mush69]

I am not sure what code to use for this BT Shunt clot removal.


1. Pulmonary atresia with ventricular septal defect status post modified
Blalock-Taussig shunt.
2. Acute shunt thrombosis.

OPERATION: SHUNT EXPLORATION AND REVISION

INDICATIONS: a 12-month-old with pulmonary atresia and ventricular
septal defect who underwent initial palliation with a modified Blalock-Taussig
shunt. He was taken to the Operating Room by Dr. earlier today for a
redo fundoplication repair of a hiatal hernia. He returned back from the
Operating Room with some decrease in saturations and increasing oxygen
requirements. On physical exam, his shunt murmur was no longer detected and a
transthoracic echocardiogram failed to confirm flow through his
Blalock-Taussig shunt. All this was consistent with acute shunt thrombosis.
He is being taken to the Operating Room emergently for intervention.

FINDINGS: Complete thrombosis of his shunt was identified. The clot was
removed and flow was reestablished with return of oxygenation and with minimal
supplemental oxygen. This was able to be accomplished without
cardiopulmonary bypass due to the development of aortopulmonary collaterals
maintaining some pulmonary circulation.

TECHNICAL DESCRIPTION: Patient was taken emergently from the Pediatric
Intensive Care Unit where he was already intubated and taken down to the
Operating Room. He was placed under general endotracheal anesthesia and his
chest, abdomen, and groins were prepped and draped in a routine sterile
fashion. A redo median sternotomy was performed. The previous midline scar
was excised and soft tissues were divided with electrocautery down to the
level of the sternum. The sternal wires were removed. The sternum was
divided under direct vision. The aorta was dissected free from the
surrounding tissues and the Gore-Tex shunt was identified. There was no flow
noted. The patient was systemically anticoagulated with Heparin. The shunt
was clamped proximally and distally and a small transverse incision was made
within the shunt. The presence of clot was immediately identified. The
proximal portion of the shunt was unclamped and all the clot was removed by
direct visualization as well as with a Fogarty catheter. The shunt was then
reclamped. The distal shunt was unclamped and all clot was removed under
direct vision as well as with a Fogarty catheter. The shunt was then
irrigated out with Heparin containing solution. The shunt was reapproximated
with interrupted 6-0 Prolene sutures. The clamps were then removed and the
flow was reinstituted through the shunt. The Doppler signal was excellent and
immediately oxygen saturations began to rise with diminishing oxygen
requirements. The Heparin was not reversed. Hemostasis was obtained locally.
A mediastinal drain was inserted. The sternum was then reapproximated with
interrupted stainless steel wires. The soft tissues were closed with two
layers of running Vicryl and the skin was closed with a running monofilament
suture. Benzoin and Steri-Strip was applied. The baby remained intubated and
was taken back to Pediatric Cardiac Intensive Care Unit in stable condition.

 

[dimmitta]

I would look at CPT 35875 if there was no PTFE graft used during the original shunt procedure. If PTFE was used in original modified BT shunt you could bill the 33750 (BT Shunt) code again with a 52 modifier for reduced service. If it's still in the global period it would need a 78 modifier as well. You could ask the physician which of these he thinks represents the actual procedure best...if you have access to the physician. Hope this helped!