Ask Dr. Z

If a CHD patient receives a heart transplant, are heart cath and echos coded as congenital or non-congenital? Physicians insist on congenital, but problem then is what congenital diagnosis can we use if it no longer exists? Also, see the following example of patient with post transplant complex anatomy. Should this patient be coded as congenital? Patient's native IVC and SVC were left-sided; complex re-routing of the systemic veins was performed at the time of his transplant. A flap of atrial tissue was used to redirect the IVC to the right atrium, while the donor innominate vein was anastomosed to the recipient left-sided SVC to the right atrium. Instead of using a congenital code, should we be adding a modifier -22 for this patient?