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open hemothorax drainage

Krisan Posted Tue 28th of April, 2015 13:26:22 PM

cardioTHORACIC coding question:

Three days ago patient had aortic valve replacement and required ECMO and CHEST WAS LEFT OPEN. Now has tamponade and is back in OR for mediastinal washout, drainage of right hemothorax, and drainage of left serous effusion. Which code(s) should we report for the second surgery? Thanks.

op note excerpt...
The 2 prior lap sponges were removed very carefully. The 3 Blake drains in the mediastinum were removed temporarily and aspirated off clot. The lung was very edematous and protruding from the wound very carefully. A sump sucker was placed in the right chest. Over 2 liters of hemorrhagic fluid was drained from the right chest. This immediately relieved the tamponade physiology. We were able to then flow from 2 liters per minute to 4 liters per minute. The mixed venous sats then normalized to greater than 70%. In addition, the MAP, mean perfusion pressure, had improved and we were able to wean off the vasopressin and weaned off the vasopressin from 0.04 to 0 and Levophed from 14 to 4. Overall, this maneuver is draining the right chest, improved hemodynamics significantly.

The sternal retractor was carefully applied. The pericardial sutures were used to create a pericardial well. The mediastinum was irrigated with warm antibiotic irrigation. There appeared to be bright red blood that was oozing from the aortic cannulation site. The 2 concentric pursestring sutures appeared to be loose. These were then tightened up and readjusted. This appeared to control the bleeding, which was at the entry site. In addition, the aortic cannula appeared to have receded and retracted from the aorta and this was advanced into the aorta. The aortic root stitch site appeared to be hemostatic. There was no evidence of any venous bleeding.

An 32-French right angle chest tube then was placed in the right chest. A 32-French right angle chest tube was placed in the left chest. The left chest drained approximately a liter of serous effusion.

The mediastinum including the sternum and the subcutaneous tissue then was irrigated with 3 L of warm antibiotic irrigation with Kefzol using the Pulse irrigator system.

SuperCoder Answered Wed 29th of April, 2015 03:43:01 AM

AAE does not provide coding for operative reports and chart notes.

SuperCoder offers SuperCoding on Demand (SOD) (http://www.supercoder.com/coding-answers/coding-on-demand) for coding of an operative report or chart note and you can contact (866)228-9252 or e-mail customerservice@supercoder.com for more information.

Krisan Posted Thu 30th of April, 2015 12:33:13 PM

I included the op note excerpt only because I've seen it requested by so many of the SuperCoder responders. The question is included at the beginning of the initial inquiry and remains unchanged: Three days ago patient had aortic valve replacement and required ECMO and CHEST WAS LEFT OPEN. Now has tamponade and is back in OR for mediastinal washout, drainage of right hemothorax, and drainage of left serous effusion. Which code(s) should we report for the second surgery? Thanks.

SuperCoder Answered Fri 01st of May, 2015 07:40:54 AM

Well, there is no code appropriately representing the procedure performed therefore I am leaning towards the unlisted CPT 32999 for the performed procedure.

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