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Questions and Answers
What are the CPT® and ICD-10-CM codes reported for the placement of the pacemaker leads?
33202, 33224-51, I25.5, I45.9, I50.9
What are the CPT® and ICD-10-CM codes reported for the repair of the sinus of Valsalva aneurysm?
33720, Q25.49
What are the CPT® and ICD-10-CM codes reported for the repair of the descending thoracic aortic aneurysm?
33875, I71.2, I71.01
What are the CPT® and ICD-10-CM codes reported for the re-replacement of the tricuspid valve?
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What are the CPT® and ICD-10-CM codes reported for the removal of varicose veins?
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What are the CPT® and ICD-10-CM codes reported for the pericardial window procedure?
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What are the CPT® and ICD-10-CM codes reported for the left subclavian Vas-Cath placement?
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What is the preoperative diagnosis for Case 1?
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What is the postoperative diagnosis for Case 1?
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What operation was performed in Case 1?
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What are the reported CPT® and ICD-10-CM codes for Case 1?
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What is the primary diagnosis code for Case 2?
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How many vessels were bypassed in Case 2?
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What operation was performed in Case 2?
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What are the reported CPT® and ICD-10-CM codes for Case 2?
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What was the main reason for surgery in Case 3?
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What operation was performed in Case 3?
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What are the reported CPT® and ICD-10-CM codes for Case 3?
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What was the preoperative diagnosis for Case 4?
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What operation was performed in Case 4?
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Study Notes
Case 1: Triple Vessel Bypass and Aortic Valve Replacement
- Preoperative diagnoses include severe two-vessel coronary artery disease and moderate aortic stenosis.
- Postoperative findings confirmed the same diagnoses.
- Operative procedures included triple-vessel coronary bypass grafting and aortic valve replacement.
- Key occlusions: 70% in distal left main, 80% in proximal left anterior descending (LAD), and 95% in proximal ramus intermedius.
- Significant aortic valve gradient measured at 40 mm Hg, indicating severe stenosis.
- Anesthesia was general; performed under cardiopulmonary bypass.
- Vein and arterial grafts included left internal mammary to LAD and reverse saphenous veins to diagonal branches.
- 23 mm bovine pericardial bioprosthesis used for the aortic valve replacement.
- CPT® and ICD-10-CM codes: 33405, 33533-51, 33518, 33508, I35.0, I25.110.
Case 2: Coronary Artery Bypass Graft x 4
- Preoperative diagnoses: Coronary artery disease and hypercholesterolemia.
- Surgical intervention included four coronary artery bypass grafts (CABG).
- Operative techniques: Left internal mammary artery to obtuse marginal artery, right internal mammary artery to LAD, with two reverse saphenous vein grafts.
- Patient history included hypertension; presented with a positive stress test indicating ischemic heart disease.
- Anesthesia: General endotracheal; procedure completed with use of cardiopulmonary bypass.
- Five bypass grafts methodically anastomosed using 6-0 and 7-0 Prolene sutures.
- CPT® and ICD-10-CM codes: 33534, 33518, 33508, I25.10, E78.00.
Case 3: Aortic Valve Replacement and CABG x 2
- Preoperative diagnoses: Critical aortic valve stenosis, coronary artery disease, hypertension, diabetes mellitus.
- Aortic valve replacement performed with a 19 mm St. Jude bioprosthesis.
- Two coronary artery bypass grafts executed using reverse saphenous vein grafts.
- Significant findings included severe calcification of the aortic valve as well as critical aortic valve stenosis.
- General anesthesia induced; procedure involved opening of the mediastinal cavity.
- Cardiopulmonary bypass employed to facilitate precise surgical intervention during valve reemplazo.
- Thorough examination confirmed graftable vessels with satisfactory flow measurements.
- CPT® and ICD-10-CM codes: 33405, 33511-51, 33508, I35.0, I25.10, I10, E11.9.
Case 4: Insertion of Ventricular Pacemaker Lead
- Preoperative diagnoses comprised ischemic cardiomyopathy, intraventricular conduction delay, and congestive heart failure.
- Procedure focused on the insertion of a left ventricular epicardial pacemaker lead and generator change.
- Patient had a dual-system pacemaker that required generator replacement.
- Surgery accessed through a left posterior thoracotomy technique for lead placement.
- Antibiotic saline used for irrigation post-explantation; reconnections verified adequate thresholds.
- Single left pleural drain placed; patient transferred to the coronary care unit post-op in stable condition.
- CPT® and ICD-10-CM codes: 33202, 33224-51, I25.5, I45.9, I50.9.
Case 5: Repair of Sinus of Valsalva Aneurysm
- Preoperative diagnosis indicated a sinus of Valsalva aneurysm on the left coronary sinus.
- Postoperative status confirmed the same diagnosis post-repair.
- Operation involved the repair of the aneurysm using a pericardial patch.
- Factors included administration of general endotracheal anesthesia and standard surgical preparations.
- Rectal temperature monitoring, Foley catheter, and TEE probe utilized during the surgery.
- Patient care included meticulous surgical techniques and procedural rigor to ensure patient safety.### Procedure Overview
- Median sternotomy used for chest opening, allowing access to the heart and surrounding structures.
- Patient fully heparinized and placed on cardiopulmonary bypass for surgical intervention.
Pericardial Dissection
- Significant adhesions and blood-tinged fluid encountered upon opening the pericardium.
- Tonsil clamps assisted in managing the pericardial sac and dissecting adhesions.
- Right atrium and aorta exposed; lighter adhesions on the left ventricle addressed by finger dissection.
Aortic Aneurysm Repair
- Aortotomy performed to access and identify the aneurysm.
- Removal of thrombus; decision made not to debride laminar thrombus adhered to aneurysm.
- Aneurysm located at the left side of the sinus of Valsalva, with coronary artery easily probed.
Surgical Technique
- Bovine pericardial patch sized and sutured in place using 4-0 Prolene suture in a running technique.
- Ensured complete exclusion of the aneurysm while retaining tissue integrity for coronary reconnection.
Postoperative Monitoring and Closure
- Cardioplegia given retrograde, confirming competent repair with no aortic insufficiency noted.
- Chest closed with stainless steel wires, fascia closed using Vicryl sutures, and skin closed with similar technique.
CPT® and ICD-10-CM Code Definition
- CPT® Code: 33720
- ICD-10-CM Code: Q25.49
Case Details for Aortic Aneurysm Repair
- Left thoracotomy performed for a 6.7 cm descending thoracic aortic aneurysm with type B dissection.
- Heparin administered, followed by partial bypass to maintain lower extremity blood pressure during surgery.
- Aortic cross-clamping and controlled luminal resection ensured proper repair technique.
Graft Placement
- 34 mm Gelweave graft utilized for repair; careful attention to anastomosis to prevent leaks.
- Utilized pledgeted sutures for reinforced closure.
Postoperative Condition
- Patient tolerated procedure well; all incisions closed and monitored post-anesthesia.
- CPT® Code: 33875; ICD-10-CM Codes: I71.2, I71.01
Tricuspid Valve Replacement
- Re-replacement of a 10 year-old tricuspid valve performed due to prosthetic valve endocarditis.
- Systemic heparin and cannulation of vessels for bypass prior to valve removal.
Valve Replacement Procedure
- 31 mm Carpentier-Edwards pericardial bioprosthesis selected; sutures placed in ventriculoatrial fashion around new valve.
- Thorough inspection and closure of the atrium to ensure stable hemodynamics post-procedure.
Postoperative Follow-Up
- Temporary drains placed; hemostasis checked before surgical site closure.
- CPT® Codes: 33465, 33530; ICD-10-CM Codes: T82.6XXA, I07.9
Varicose Vein Removal
- Multiple incisions performed for the removal of varicose veins in the right lower leg, addressing both major saphenous systems.
- All segments excised down to the knee with meticulous hemostasis.
Postoperative Management for Varicose Veins
- Wrapped leg for support after surgery; no complications noted.
- CPT® Codes: 37722-RT, 37718-51-RT; ICD-10-CM Code: I83.811
Pericardial Window for Tamponade
- Subxiphoid approach utilized for pericardial window to relieve cardiac tamponade due to malignant effusion.
- Approximately 500 ml of serosanguineous fluid suctioned for cytology.
Drain Placement and Closure
- Blake drain placed on the heart's diaphragmatic surface; wounds closed post-procedure for stability.
- CPT® Code: 33025; ICD-10-CM Codes: C79.89, C34.90, I31.4
Vas-Cath Placement for Dialysis
- Left subclavian Vas-Cath placed for CVVHD; successful insertion using Seldinger technique.
- Excellent flow achieved; patient prepared for ICU transfer post-operation.
- CPT® Code: 36556; ICD-10-CM Code: N17.9
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Description
Test your knowledge on practical applications related to Chapter 10 of the AAPC. This quiz covers key concepts such as preoperative and postoperative diagnoses as well as detailed surgical procedures. Challenge yourself and reinforce your understanding of cardiology procedures.
