Coding guidelines for Coronary artery bypass procedures CABG

 

1

2 types of Coding guidelines for Coronary artery bypass procedures  

1. Venous grafts include procurement of the venous graft(s) as an integral component of the procedure
2. 37700-37735 (Ligation of saphenous veins) shall not be reported separately for procurement of the venous grafts.

What are the 6 Codes for CABG with a Vein Only

1. 33510 – Coronary artery bypass, vein only; single coronary venous graft
2. 33511 – Coronary artery bypass, vein only; 2 coronary venous grafts
3. 33512 – Coronary artery bypass, vein only; 3 coronary venous grafts
4. 33513 – Coronary artery bypass, vein only; 4 coronary venous graft
5. 33514 – Coronary artery bypass, vein only; 5 coronary venous grafts
6. 33516 – Coronary artery bypass, vein only; 6 or more coronary venous grafts

What are the 4 Codes for CABG with an Artery

• 33533 – Coronary artery bypass, using arterial graft(s); single arterial graft

• 33534 – Coronary artery bypass, using arterial graft(s); 2 coronary arterial grafts

• 33535 – Coronary artery bypass, using arterial graft(s); 3 coronary arterial grafts

• 33536 – Coronary artery bypass, using arterial graft(s); 4 or more coronary arterial graft

Add-On Codes for Bypass Grafting with a Vein When There Is Also an Arterial Bypass Graf

• 33517 – Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (List separately in addition to code for primary procedure)

• 33518 – Coronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (List separately in addition to code for primary procedure)

• 33519 – Coronary artery bypass, using venous graft(s) and arterial graft(s); 3 venous grafts (List separately in addition to code for primary procedure)

• 33521 – Coronary artery bypass, using venous graft(s) and arterial graft(s); 4 venous grafts (List separately in addition to code for primary procedure)

• 33522 – Coronary artery bypass, using venous graft(s) and arterial graft(s); 5 venous grafts (List separately in addition to code for primary procedure)

• 33523 – Coronary artery bypass, using venous graft(s) and arterial graft(s); 6 or more venous grafts (List separately in addition to code for primary procedure)

What is 4 important guidelines – Harvesting of Vessels for CABG

 

1. 35500 – Harvest of upper extremity vein, 1 segment, for lower extremity or coronary artery bypass procedure (List separately in addition to code for primary procedure)
2. 35572 – Harvest of femoropopliteal vein, 1 segment, for vascular reconstruction procedure (eg, aortic, vena caval, coronary, peripheral artery) (List separately in addition to code for primary procedure)
3. 35600 – Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure (List separately in addition to code for primary procedure)
4. 33508 – Endoscopy, surgical, including video-assisted harvest of vein(s) for coronary artery bypass procedure (List separately in addition to code for primary procedure)

Coding guidelines for coronary artery graft: (Best coding)

Code is based on the number of vessels bypassed

• Type of vessel used for the graft (artery and/or vein)

• If only venous grafts are being utilized for the bypass procedure, report a code from the 33510-33516 range

• If only artery grafts are being utilized report cod from the 33533-33536 range

• If combined arterial-venous grafting then code for Artery from 33510-33516 and for venous 33517-33523. Do not code number venous from 33533-33536.

• Percutaneous VAD – 33990-33993

Harvesting guidelines:

• Saphenous vein to be used for bypass is included in codes 33510-33516

• Harvesting of other veins (e.g., upper extremity vein) is not bundled

• Harvesting of an upper extremity vein is reported separately with code 35500

• Harvesting a femoropopliteal vein is reported separately with code 35572

• If endoscopy is utilized to assist in harvesting of any vein , it is reported separately with code 33508

Advantage / benefit of Modifier :

Modifier 22 may be appended with main procedure if there is more work involved Assistant for graft procurement – Modifier 80

List if include/exclude procedure in Graft procedure:

 

If absence of follow points leads to incorrect coding

• Epi-aortic ultrasound CPT code 76998 (Ultrasonic guidance, intraoperative) may be reported with graft procedure with 59/XS modifier

• CPT code 76998 shall not be reported for ultrasound guidance used to procure the vascular graft.

• If an upper extremity artery is selected as the vessel to use for the graft instead of an internal mammary artery, harvesting the upper extremity artery is reported separately with code 35600. Code 35600 is reported with codes 33533-33536.

• Insertion of the cannulas into the venous and arterial circulation shall not be reported separately with graft code

• Insertion or replacement of temporary transvenous single and dual chamber cardiac electrodes or pacemaker catheters (33210 and 33211) shall not be reported with open or percutaneous cardiac procedures performed at the same patient encounter.

• 36800-36861 (Hemodialysis access, intervascular cannulation, shunt insertion) include the “separate procedure cannot be reported with main procedure

• Opening and closing the chest are included in the bypass graft codes

• Do not report codes for sternal closure (any method, including plates) when the sternum is closed following the bypass procedure.

• When a thromboendarterectomy is performed at the site of an aneurysm repair or graft insertion, the thromboendarterectomy is not separately reportable.

• If a bypass procedure requires an endarterectomy to insert the bypass graft, only the code describing the bypass may be reported. The endarterectomy is not separately reportable

• If the aneurysm repair and a bypass are performed at separate non-contiguous sites the aneurysm repair code and the bypass code may be reported with an anatomic modifier or modifier 59 or XS.

• If a thromboendarterectomy is medically necessary due to vascular occlusion in a different vessel, the appropriate code may be reported with an anatomic modifier or modifiers 59 or XS indicating that the procedures were performed in non-contiguous vessels.

• Bypass grafts (CPT codes 35500-35683) include blood vessel repair. CPT codes 35201-35286 (Direct repair, repair with vein graft, and repair with graft other than vein) shall not be reported with a bypass graft code for the same anatomic site.

• CPT codes 35800-35860 describe treatment of postoperative hemorrhage requiring return to the operating room. These codes shall not be reported for the treatment of hemorrhage during the initial operative session nor treatment of postoperative hemorrhage not requiring return to the operating room. These codes should generally be reported with modifier 78, indicating that the procedure represents a return to the operating room for a related procedure in the postoperative period.

Example for better understanding:

PROCEDURE:

1. Right axillary artery cannulation.

2. Re-do sternotomy.

3. Endoscopic vein harvest.

4. Coronary bypass grafting x1 with saphenous vein graft to the posterior descending branch of the right

Code(s): 33508, 33510, 33530

Example 2:

PROCEDURE:

1. Coronary bypass graft x3 using LIMA to LAD, SVG to PDA and diagonal.

2. Endoscopic vein harvest. The saphenous vein harvesting

Codes: 33508, 33518, 33533

• One arterial bypass- 33533

• Two saphenous vein bypass 33518

• The saphenous vein harvesting is included in code 33518

• Endoscope to guide harvesting of the vein is reported separately with code 33508.