Question

A four-month-old boy with Tetralogy of Fallot was admitted for surgical repair. At surgery, cardiopulmonary bypass was established; the ligamentum was ligated; the thymus was resected; the right ventricle outflow tract (RVOT) was divided and widened; and closure of VSD was done with a Gore-Tex patch.

Since the repair can be performed at various stages, the ICD-10-PCS code assignments for the surgery to correct tetralogy of Fallot may be different for each case. For this particular case, assign the following ICD-10-PCS codes:

a. 02NK0ZZ, Release of right ventricle, open approach (for the widening of the right ventricular outflow tract).

b. 02UM0JZ, Supplement ventricular septum, with synthetic substitute, open approach (for the closure of the ventricular septal defect with Gore-tex©patch)

c. 07TM0ZZ, Resection of thymus, open approach

d. 5A1221Z, Performance of cardiac output, continuous (for the cardiopulmonary bypass)18

Answer 1

Answer:Tetralogy of Fallot (TOF) with subarterial ventricular septal defect (VSD) is more common among Asians than Caucasians. Compared with the regular subaortic VSD postoperative right ventricular outflow obstruction is more common because of the sub-pulmonary extension of the defect. The objective of this study is to analyze the surgical implications and outcomes of patients with TOF - subarterial VSD in the current era.

Patients and Methods:

In all, 539 consecutive operated patients with TOF from May 2005 to September 2012 were retrospectively reviewed. Eighty-five patients had subarterial VSD. Seventy-nine of these underwent intracardiac repair. Preoperative clinical, echocardiographic features, operative and postoperative variables were assessed.

Results:

The median age at surgery was 6 years and the median weight was 14 kilograms. The male to female ratio was 1.7:1. TOF with subarterial VSD was associated with frequent use of transannular patch (74.6%). The early mortality was 2.5%. Follow up was 92% complete with a mean duration of 20 months with actuarial survival of 97.3% at 5 years. Two patients required reoperation for significant right ventricular outflow tract obstruction (RVOTO) at one year and three years, respectively.

Step-by-step explanation: