A two-year-old male with Tetralogy of Fallot with pulmonary atresia, and major aortopulmonary collateral arteries (MAPCA) presents for pulmonary artery unifocalization. Via a redo median sternotomy, the pericardium was accessed and the Blalock-Taussig (BT) shunt was doubly ligated and divided. Non-duplicate MAPCAs to the left and right lung were taken off the descending aorta and unifocalized together with the native pulmonary arteries (PAs). These required extensive patching with PhotoFix (bovine) pericardium. A right ventriculotomy was performed, and an 8 mm Gore-Tex® conduit was sewn into the unifocalized PAs distally and the right ventricular outflow tract proximally. How is pulmonary artery unifocalization coded?
Assign the following ICD-10-PCS codes:
021K0JP Bypass right ventricle to pulmonary trunk with synthetic substitute, open approach, for the Gore-Tex® portion of the bypass conduit; and
02UP08Z Supplement pulmonary trunk with zooplastic tissue, open approach, for pulmonary artery plasty using PhotoFix (bovine) pericardium to form a single pulmonary artery trunk conduit for the distal anastomosis with the Gore-Tex®.In unifocalization, the misdirected blood vessels are rerouted into a single vessel (or into the pulmonary artery if it is present), which is then attached to the right ventricle of the heart through a conduit.
A patient with a thoracoabdominal aortic dissection presents for repair. After median sternotomy, the ascending aorta was divided and trimmed down to the sinotubular junction. A Hemishield Dacron graft was fashioned end-to-end to the aorta at the junction. The ascending aorta was further abbreviated to allow hemiarch resection. A Gore-Tex® fixed elephant trunk endoprosthesis was then passed into the open arch, under direct vision. The endograft was deployed and secured to the edge of the hemiarch incision on the lesser curvature. A hole was developed in the endograft for the left subclavian artery. Through this, a Gore Viabahn covered endograft was passed into the left subclavian artery and remained in the lumen. The subclavian endograft was secured with sutures to the aortic endograft, which was then sewn to the aortic arch. Then another piece of Hemishield graft was beveled to size and anastomosed end-to-end to the aortic arch. What are the correct ICD-10-PCS codes for repair of the aorta with hemiarch Dacron graft replacement, fixed elephant trunk Gore-Tex® endograft, and placement of endograft in the left subclavian artery origin?
Assign the following procedure codes:
02RX0JZ Replacement of thoracic aorta, ascending/arch with synthetic substitute, open approach, for the replacement of a portion of the ascending aorta with Dacron;
02VW0DZ Restriction of thoracic aorta, descending with intraluminal device, open approach, for the endoprosthesis placed in the descending portion of the thoracic aorta; and
03H40DZ Insertion of intraluminal device into left subclavian artery, open approach, for the endograft extension placed in the left subclavian.The hybrid repair of complex aortic aneurysms using aortic arch replacement along with a fixed elephant trunk endograft is a relatively new surgical technique. As in this case, it can be performed as a single procedure, using a replacement prosthesis for the proximal portion of the aorta and an endograft in the distal portion. These techniques are separate surgical objectives classified as different root operations in ICD-10-PCS, and so separate codes are assigned. In this particular case, an endograft extension was placed from the thoracic aorta endograft into the subclavian artery to maintain patency of the subclavian. It is coded separately using the root operation Insertion because the subclavian extension is not integral to aortic aneurysm repair.