Ask Dr. Z

CT surgeon came to case for mediastinal exploration, control of hematoma, removal of foreign body, and ligation of left atrial appendage due to Watchman perforation of left atrial appendage. Cardiopulmonary bypass was initiated. It was found that the Watchman device had perforated and was completely out of the left atrial appendage but was still attached to the deployment catheter. The catheter was used to re-snare and bring the Watchman into it. The catheter was backed out of the heart. The LAA was ligated and sutured. 

Surgeon reported codes 35820 and 33268, but also wants to bill for removal of foreign body, which would be the Watchman/catheter. Please advise if backing out of the catheter with Watchman re-snared would qualify for removal of foreign body. We considered 33515 for cardiotomy with removal of foreign body, but this was documented as a repair by removing the LAA. Please advise.