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CPT Ref Guide

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Diagnosis Coding: A Crucial Link in Reporting Complex Congenital Anomalies to aid in future median sternotomies. The sternum is closed with wires; the abdominal fascia, skin, and subcutaneous tissue are closed in layers. Sterile dressing is applied, and the patient is stabilized and transferred to the intensive care unit. CODING TIP Code 33622 may be reported with add-on code 33768 if a bilateral bidirectional Glenn is performed. CARDIAC ASSIST—INTRA-AORTIC BALLOON ASSIST DEVICE 33967 Insertion of intra-aortic balloon assist device, percutaneous CPT Assistant Feb 02:2; CPT Changes: An Insider’s View 2002 33968 Removal of intra-aortic balloon assist device, percutaneous CPT Assistant Nov 99:19, Jan 00:10; CPT Changes: An Insider’s View 2000 33970 Insertion of intra-aortic balloon assist device through the femoral artery, open approach CPT Assistant Nov 99:19; CPT Changes: An Insider’s View 2000 Intent and Use of Code 33968 33971 Removal of intra-aortic balloon assist device including repair of femoral artery, with or without graft 33973 Insertion of intra-aortic balloon assist device through the ascending aorta 33974 Removal of intra-aortic balloon assist device from the ascending aorta, including repair of the ascending aorta, with or without graft Intent and Use of Codes 33967-33974 Codes 33967-33974 represent procedures and approaches performed in association with insertion and removal of an intra-aortic balloon assist device (IABAD). An IABAD is intended to decrease the workload of the heart and increase blood flow to the heart and the rest of the body. The IABAD is used temporarily for emergency cardiac support conditions such as stabilization of patients with acute myocardial infarction referred for urgent cardiac surgery. Other usages include managing patients with refractory ven- tricular failure outside the setting of acute myocardial infarction, such as those with cardiomyopathy or severe myocardial damage associated with viral myocarditis, Code 33968 is used to report percutaneous removal of an intra-aortic balloon assist device. Description of Service for Code 33968 The surgeon weans the patient off the intra-aortic bal- loon assist device by slowly decreasing the assistance of the balloon from a 1:1 ratio of pump-to-normal to a 1:3 ratio of pump-to-normal beat. Cardiac output is measured continuously after each change. When it is determined that the patient’s heart is beating satisfac- tory on its own, the retaining sutures are cut, and the IABAD is carefully removed from the aorta and exited through the femoral artery incision site. The surgeon then administers compression on the large femoral artery puncture site for a period of time to assure hemo- stasis. Femoral artery and lower extremity pulse are checked for thrombosis and assure viable vasculariza- tion to the lower legs and feet. Intent and Use of Code 33971 Code 33971 should be used to report the removal of an IABAD when a surgical repair of the artery is necessary. 73 management of cardiogenic shock not rapidly reversed by pharmacological therapy, or stabilizing patients with refractory ventricular ectopy after myocardial infarc- tion. Code 33967 should be reported when a physician inserts an IABAD by percutaneous techniques. Description of Service for Code 33967 Preprocedure work includes patient evaluation and assessment and discussion of the reason for the proce- dure and its risks. The procedure may be performed in the cardiac catheterization laboratory, in the operat- ing room, or at the bedside, depending on the clinical circumstances. Using sterile technique with local anesthetic and sedation, access to the femoral artery is accomplished, and a sheath is placed over a guidewire. The IABAD is placed under fluoroscopic control with its tip just distal to the left subclavian artery. In the absence of fluoroscopy, the catheter is placed over a long guidewire for a predetermined distance measured prior to insertion, using external landmarks. Following catheter placement, the physician supervises the initia- tion of balloon pumping, assuring that timing and augmentation are correct and effective. The IABAD is then secured in place and dressed. CHAPTER 3

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