Ask Dr. Z

Can we report both codes 33477 and 33745? Is the RVOT stent placement in the valve deployment zone, or is it considered pre-stenting (33477)?

"Status post bioprosthetic pulmonary valve replacement with an enlarging right ventricular outflow tract pseudoaneurysm, which has been causing worsening sub-pulmonary stenosis. There has been concern that when his anticoagulated and in the setting of significant RV hypertension, the RVOT pseudoaneurysm continues to enlarge, worsening his sub-pulmonary stenosis and the strain on his right heart. I noted that he had a severely reduced cardiac index at 1.86 L/min/m2 and a 40 mmHg gradient from the right ventricle to just above the bioprosthetic valve due to the sub-pulmonary obstruction and compression by the RVOT pseudoaneurysm. The procedure included diagnostic right and left heart catheterization with oximetry hemodynamics and angiography. Intervention included stent placement in the right ventricular outflow tract and transcatheter pulmonary valve implantation."