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Code This!

Scenario Week of December 07, 2011:
View Current Scenario

PRE-OP DIAGNOSIS: Aortic valve stenosis
OPERATION: Transcatheter aortic valve replacement (TAVR)
POST-OP DIAGNOSIS: Aortic valve stenosis

SUMMARY:
A patient with severe aortic valve stenosis presents for TAVR (transcatheter aortic valve replacement). A diagnostic cardiac catheterization performed at a previous outpatient encounter was negative for significant coronary artery disease or other pathology and confirmed candidacy for endovascular replacement. The TAVR procedure was performed via an endovascular approach, utilizing a transfemoral artery technique. Balloon valvuloplasty was performed adjunct to deployment of a bioprosthetic aortic valve.

OPERATIVE PROCEDURE:
The patient was prepped, draped, and transported to the operating suite with cardiopulmonary bypass on standby. Access was obtained through the femoral artery at the groin. The valve assembly was mounted on a specialized delivery catheter. A balloon tip catheter was advanced through the aorta to the aortic valve. A balloon valvuloplasty was performed with destruction of the native structure. The valvuloplasty catheter was removed, and the delivery catheter was advanced through the aorta to the valvuloplasty site. The bioprosthetic aortic valve was positioned and expanded in situ, attached to a stent frame across the native valve remnants. Once optimal placement was achieved, the prosthetic valve was tested and determined to be at optimal function.

Assign the appropriate ICD-9-CM diagnosis and procedure codes, and the appropriate CPT code(s).


ANSWERS

ICD-9-CM Diagnoses and Procedure(s)
424.1 Aortic valve stenosis
35.05 Endovascular replacement of aortic valve

Rationale:
New ICD-9-CM diagnosis codes were created effective October 1, 2011, to specifically report the transcatheter heart valve replacement technique, with differentiation between endovascular and transapical approaches. Balloon valvuloplasty is inherent to the procedure and is not reported separately. Heart valve replacement by open and other approach is excluded from endovascular codes 35.05–35.09.

CPT Procedure
0256T Implantation of catheter-delivered prosthetic aortic valve, endovascular approach

Rationale
Code 0256T includes catheterizations inherent to the primary procedure, any temporary pacing, contrast injection or fluoroscopic imaging, supervision, and guidance. However, code 0256T does not include cardiac catheterization when performed at the time of the TAVR procedure for diagnostic purposes. In those circumstances, code and report the diagnostic catheterization procedure in addition to the primary TAVR procedure.

 
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