Ask Dr. Z

The patient came in for an aortic valve replacement (33405). After the valve was placed, a hematoma was discovered and a repair with a wrap took place. Code 33859 states for aortic disease other than dissection. We are unable to locate a resource that shows a hematoma would fall within the guidelines for the graft placement. Would the hematoma/wrap be best supported with 33999 compared to the 33859?

"Normal functioning of the mechanical valve with no evidence of valvular nor perivalvular insufficiency. The heparin effect was reversed with protamine and decannulation was carried out surgical hemostasis was assured. Patient did have evidence of subadventitial superficial hematoma overlying the mid ascending aorta just distal to the aortotomy site in this area of the aorta was reinforced with an adventitial wrap of using a Dacron graft and a running 3-0 Prolene suture."