Wiki Composite Coronary Graft

[j.monday7814]

Surgeon performed CABG using autogenous grafts procured from the saphenous vein and left internal mammary artery. routine surgery until he attempts to place the graft from IMA to LAD and finds the graft is too short so he uses a piece of SVG to connect the IMA to the LAD

so the native LAD is bypassed using SVG then to IMA then to the ascending aorta. I can't find a code for composite coronary graft, 35681-35683 are not appropriate in this situation.

there were also SVG grafts to the first diagonal and left circumflex, so I could see it argued that 33533 (1 arterial graft) w/ 33519 (3 vein grafts) or 33533 (mod 22) w/ 33518 or even 33512 (mod 22).

Any ideas?? maybe even an unlisted code??

 

[j.monday7814]

After much research and debate with my fellow coders, we decided to bill 33533 with 33518 (SVG to diag and LC) with a modifier 22 on the 33533 for the extra work involved with the composite graft. I'm surprised no one else has come across this. I'm sure this is very rare and hopefully I won't have to do it again for a very long time.

 

[Margaret Morgan]

I would have billed it as 33533 and 33519 to best reflect the amount of work done and the CABG coding rules as I learned it from our eduction coder.

 

[j.monday7814]

I would have billed it as 33533 and 33519 to best reflect the amount of work done and the CABG coding rules as I learned it from our eduction coder.

I considered that as an option but I didn't think it would be accurate coding because that is essentially billing for 4 bypass grafts, but the patient only had 3 coronary arteries bypassed. Also, 33519 includes end-to-side anastomosis for the vein graft to the native artery and then the same anastomosis to the ascending aorta. In this case the vein graft was anastomosed end-to-end to the arterial graft. It seems like comparable work as far as I understand but I think it is too risky to assume that.