Ask Dr. Z

Patient was planned to get valve replacement and CABG at same time. The note says: "Pre-op TEE showed moderate aortic stenosis with aortic valve area of 1 cm and mean gradient of 36 mmHg. There was moderate-to-severe aortic regurgitation, hence I was planned to do the aortic valve replacement, but after sternotomy when I inspected the aorta, there was significant calcification in the ascending aorta and actual calcification in the aortic root. At this stage, I thought that doing aortic valve replacement has very high risk for stroke, hence I decided to do off-pump coronary artery bypass surgery, and we will plan on doing TAVR in the near future. Since the patient had a moderate-to-severe aortic regurgitation, I was not very comfortable lifting the heart to do the OM anastomosis, hence we ended up doing only two anastomoses LAD and distal right. " I would imagine doing a CABG without bypass makes this more complicated and risky. Should modifier -22 be used? Or, other coding instructions apply here? I'm impressed this can even be done! Wow!