YCI Frank Susnow Using the coding techniques you have learned,

YCI Frank Susnow Using the coding techniques you have learned, carefully read through the case study and determine the most accurate diagnosis code(s). Remember, check the chapter-specific, subchapter-specific, and category-specific notations within the Tabular List. Then, determine the most accurate procedure code(s) along with any modifier(s), if appropriate. WINTER HILLS HOSPITAL 565 VENTURA BYPASS • CENTRAL, FL 32811 • 407-555-4798 PATIENT: SUSNOW, FRANK ACCOUNT/EHR #: SUSNFR001 Surgeon: Keith Surnan, MD Asst. Surgeon: Ethan Harrison, MD Preop DX: Status post-coronary artery bypass grafting, remote, with closed bypasses Postop DX: Same Operative Procedure: 1. Redo median sternotomy and open-heart 2. Cardiac bypass grafting Anesthesiologist: Jacob Brighton, MD Anesthesia: General INDICATIONS: This is a 49-year-old male patient who underwent previous coronary artery bypass at the VA Hospital with closure of all the grafts and, most recently, very unstable angina pectoris. At the time of surgery, which was approached through a redo median sternotomy due to poor peripheral pulses, we elected to cannulate again the ascending aorta. The left internal mammary artery was a good vessel, which was anastomosed to the junction of the diagonal and the upper left anterior descending. This was a good vessel. We elected to do distal anastomosis to the distal left anterior descending, as well as bypass the circumflex on the right. The operation was accomplished through a redo median sternotomy. OPERATION: Following placement of Swan-Ganz catheter and induction of anesthesia, the chest was carefully re-entered. Adhesions were lysed. The patient was heparinized, and we cannulated the ascending aorta. It is worth mentioning the fact that the patient was markedly ischemic with PA pressures in the mid-50s. We instituted cardiopulmonary bypass and hypothermia. The aorta was cross-clamped. Cardioplegia solution was given through the aortic root. Following dissection of the mammary, individual segments of saphenous vein were anastomosed to the circumflex, distal left anterior descending and right coronary artery, which were good vessels. The left internal mammary artery was anastomosed to the upper left anterior descending diagonal junction. The two proximal anastomoses for the right coronary artery and the left anterior descending were performed with aortic cross-clamp in the anterior portion of the ascending aorta. Cross-clamp time was 40 minutes. We released the aortic cross-clamp, following which we performed the proximal anastomoses of the graft to the circumflex to the side of the graft to the left anterior descending. We rewarmed and experienced no difficulty in weaning the patient from cardiopulmonary bypass. Routine decannulation and closure was performed. The patient was taken to the cardiac surgical intensive care unit in satisfactory condition. Keith Surnan, MD

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