Demonstrated severe triple vessel coronary disease

Reference no: EM133675996

Review the below captioned operative note and answer the questions below.

Pre-op DX: Severe coronary artery disease with unstable angina

Postop DX: Severe coronary artery disease with unstable angina

Operative Procedure: Cardiac bypass grafting

INDICATIONS: This is a 55-year-old male who underwent evaluation for severe coronary disease. Catheterization demonstrated severe triple vessel coronary disease with a subtotal right coronary artery and significant disease involving the left anterior descending, diagonal, and circumflex. We thought the patient could have four bypasses.

The left anterior descending disease appeared diffused. Ventricular function was preserved.

PROCEDURE: With the patient in the supine position under general anesthesia, the chest, abdomen, groin, and legs were prepped and draped in standard fashion. Saphenous vein was taken from the right leg and this wound was closed in routine fashion. Simultaneously, the chest was opened through a median sternotomy and the left internal mammary was prepared. The mammary was densely adherent to the back of the sternum at the top and we ended up dividing it at this point. The proximal end was oversewn with 3-0 Prolene and then with #2 silk and the mammary was prepared as a free graft. We then opened the pericardium and heparinized and cannulated the aorta and right atrium. We went on bypass and cooled down. The aorta was cross-clamped and cardioplegia was infused in the root. We then bypassed the right coronary artery just beyond the acute angle of the heart. It was about 2.0 mm. We then bypassed a marginal, which was in about midposition; this was about a 2.5-mm vessel. We then bypassed a diagonal, which was also 2.5 mm.

The left internal mammary, used as a free graft, was then used to bypass a 2.0-mm left anterior descending. The aortic cross-clamp was removed and three vein anastomoses were made to the ascending aorta. We then sutured the left internal mammary to the hood of the diagonal vein graft. With flow established in all four grafts, we weaned from bypass with good hemodynamics. The heart was decannulated, protamine was administered, and Hemostasis was obtained. Atrial and ventricular pacing wires were attached, and chest tubes were inserted. The mediastinum was copiously irrigated out, and we closed in layers. The patient tolerated this well and left the operating room for intensive care in stable condition.

1. In a good form paragraph, based upon the information in lecture, explain what HCCs are and why they should have the attention of providers and systems.

2. What diagnosis code(s) would be assigned to this patient?

3. Using CMS HCC V23 Excel file posted to the Lecture 09 articles, is there an HCC category assigned to this patient and if so, what is that category number?

4. If there is, using CMS HCC V23, what if any additional weighting is assigned to this patient? (There was an example of this weighting in lecture.)

5. Using the 2014 published denominator from the Family Practice Management article of $9,050, what if any additional expense would be expected for this patient and need to be reimbursed by CMS? (There was an example of this calculation in lecture.)

6. After surgery, would this patient have any additional ICD-10-CM code(s) assigned to reflect the outcome of the surgery?

Reference no: EM133675996

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