AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2018 Issue 3; Ask the Editor

Coronary Artery Bypass Graft Surgery (Revision versus Total Redo)

The patient, who is status post coronary artery bypass grafting earlier in the day, was noted to have a significant right ventricular infarction at the time of the bypass. The patient had a seemingly uncomplicated revascularization and left the operating room in hemodynamically stable condition. Later in the day, the patient had a progressive decline in her hemodynamic status. A balloon pump was placed at bedside, which did not seem to help the patient’s condition. The patient continued to have what appeared to be a right ventricular dysfunction and underwent re-exploration. Once the patient’s grafts were evaluated, it was determined that the vein graft to the right coronary artery was very tight, and the operative report noted that revision surgery of the vein graft to the right coronary artery was done. The bypass was revised from aortocoronary using saphenous vein graft to a right internal mammary pedicle with interposed saphenous vein graft in an end-to-end fashion. Is this coded as a revision of the previous bypass procedure, or would this be considered a redo and coded as a new bypass? ...

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