Operative report:
Preoperative diagnosis: Atherosclerotic heart disease
Postoperative diagnosis: Atherosclerotic heart disease
Operative procedure: Coronary bypass grafts 2 with a single graft from the aorta to the distal left anterior descending and from the aorta to distal right coronary artery.
Procedure: The patient was brought to the operating room and placed in a supine position. Under general anesthesia, the anterior chest and legs were prepped and draped in the usual manner. A segment of greater saphenous vein was harvested from the left thigh, utilizing the endoscopic vein harvesting technique and prepared for grafting. The sternum was opened in the usual fashion, and the left internal mammary artery was taken down and prepared for grafting. The flow through the internal mammary artery was very poor. The patient did have a 25-mm difference in arterial pressure between the right and left arms the right arm being higher. The left internal mammary artery was therefore not used.
The pericardium was incised sharply and a pericardial well created. The patient was systemically heparinized and placed on bicaval to aortic cardiopulmonary bypass with the slump in the main pulmonary artery for cardiac decompression. The patient was cooled to 26 degree Celsius, and on fibrillation an aortic cross-clamp was applied and potassium rich cold crystalline cardioplegic solution was administered through the aortic root with satisfactory cardiac arrest. Subsequent doses were given down the vein grafts as the anastomoses were completed and via the coronary sinus in a retrograde fashion. Attention was directed to the right coronary artery. The end of the greater saphenous vein was then anastomosed there to with 7-0 continuous Prolene disatlly. The remaining graft material was the grafted to the left anterior descending at the junction of the middle and distal third. The aortic cross-clamp was removed after 149 minutes with spontaneous cardioversion. The usual maneuvers to remove air from the left heart were then carried out using transesophageal echocardiographic technique. After all the air was weaned from cardiopulmonary bypass after 213 minutes utilizing 5g/kg/minute of dopamine. The chest was closed in the usual fashion. A sterile compression dressing was applied, and the patient returned to the surgical intensive care unit in satisfactory condition. ICD and CPT codes?
The diagnosis is mentioned as atherosclerotic heart disease and from the procedure we get it is in coronary artery. Since angina pectoris is not mentioned anywhere the ICD-10-1CM code will be I25.10 (Atherosclerotic heart disease of native coronary artery without angina pectoris)
The procedure is coronary bypass of 2 grafts. A segment of greater saphenous vein is harvested from left thigh which indicates venous grafting. Hence the code will be 33511 (coronary artery bypass, vein only; 2 coronary venous grafts)
Endoscopic vein harvesting technique is used so additional code 33508 ( endoscopy, surgical, including video- assisted harvest of veins for coronary artery bypass procedure.)
the codes will be
33511,33508,I25.10
Preoperative diagnosis: Atherosclerotic heart disease
Postoperative diagnosis: Atherosclerotic heart disease
Operative procedure: Coronary bypass grafts 2 with a single graft from the aorta to the distal left anterior descending and from the aorta to distal right coronary artery.
Procedure: The patient was brought to the operating room and placed in a supine position. Under general anesthesia, the anterior chest and legs were prepped and draped in the usual manner. A segment of greater saphenous vein was harvested from the left thigh, utilizing the endoscopic vein harvesting technique and prepared for grafting. The sternum was opened in the usual fashion, and the left internal mammary artery was taken down and prepared for grafting. The flow through the internal mammary artery was very poor. The patient did have a 25-mm difference in arterial pressure between the right and left arms the right arm being higher. The left internal mammary artery was therefore not used.
The pericardium was incised sharply and a pericardial well created. The patient was systemically heparinized and placed on bicaval to aortic cardiopulmonary bypass with the slump in the main pulmonary artery for cardiac decompression. The patient was cooled to 26 degree Celsius, and on fibrillation an aortic cross-clamp was applied and potassium rich cold crystalline cardioplegic solution was administered through the aortic root with satisfactory cardiac arrest. Subsequent doses were given down the vein grafts as the anastomoses were completed and via the coronary sinus in a retrograde fashion. Attention was directed to the right coronary artery. The end of the greater saphenous vein was then anastomosed there to with 7-0 continuous Prolene disatlly. The remaining graft material was the grafted to the left anterior descending at the junction of the middle and distal third. The aortic cross-clamp was removed after 149 minutes with spontaneous cardioversion. The usual maneuvers to remove air from the left heart were then carried out using transesophageal echocardiographic technique. After all the air was weaned from cardiopulmonary bypass after 213 minutes utilizing 5g/kg/minute of dopamine. The chest was closed in the usual fashion. A sterile compression dressing was applied, and the patient returned to the surgical intensive care unit in satisfactory condition. ICD and CPT codes?
The diagnosis is mentioned as atherosclerotic heart disease and from the procedure we get it is in coronary artery. Since angina pectoris is not mentioned anywhere the ICD-10-1CM code will be I25.10 (Atherosclerotic heart disease of native coronary artery without angina pectoris)
The procedure is coronary bypass of 2 grafts. A segment of greater saphenous vein is harvested from left thigh which indicates venous grafting. Hence the code will be 33511 (coronary artery bypass, vein only; 2 coronary venous grafts)
Endoscopic vein harvesting technique is used so additional code 33508 ( endoscopy, surgical, including video- assisted harvest of veins for coronary artery bypass procedure.)
the codes will be
33511,33508,I25.10