Ask Dr. Z

Can/should the procedure to repair intraoperative dissection be coded? "Mitralplasty with cardiopulmonary bypass was performed. Left atrium was closed with 3-0 Prolene running suture. Patient was cardioverted to sinus rhythm and came off bypass. Blood pressure was allowed to rise, venous line was removed, and ascending aorta was found to have bluish discoloration. Patient had an intraoperative aortic dissection. Right femoral artery cutdown was performed and Fem-Flex cannula inserted. Patient cooled to 20 degrees centigrade. Ascending aorta was transected proximally, and tube graft was sewn, two layers for posterior wall and one layer for anterior wall. Adentitia was preserved. Clamp was removed from ascending aorta. Aorta was transected distal to cannulation site. There was 2 cm linear cut in the aorta at the cannulation site from an extension of the cannulation orifice. We then did distal anastomosis with two layers posteriorly and one layer anteriorly. Patient was rewarmed. There was bleeding from proximal anastomosis and tear found in the intima. We redid suture line with pledgets and biological glue."