Wiki MC paid add on code with wrong primary

[dpenning]

I have a situation where we are taking over some old AR and am seeing where the add on code 33508 has been billed with 33533 which is not in the approved listed primary procedures.

Is there something I don't know about with add on codes? I always thought Medicare followed the standard CPT guidelines and NCCI edits. The appropriate primary procedures for this are 33510 to 33523.

Is MC going to wake up and come after this doc for this? Should I continue billing his charts the way he has been doing it and getting paid? That last does not seem like a wise choice to me. I cannot find anything on the MC web site about this code being paid regardless of the primary procedure.

Any info would be appreciated.

Thanks,
dawn

 

[LLovett]

These are the only 2 codes he is billing?

33508 is video-assisted harvest of vein(s)

33533 is CABG using arterial graft(s); single arterial graft.

These two do not go together, if no vein was used how/why would he harvet it with video-assistance?

My opinion is they need to self report and refund any 33508 procedures that were paid in error.

Good luck,

Laura, CPC

 

[dpenning]

No, I'm afraid I did not state that very well. He is also billing some add on codes for one or more veins but again, they are add on codes as well when billed with 33533. I'm guessing that it is because it is endoscopic rather than open that they are paying for it, that it is the open harvest they consider included in the section instructions.

 

[Anna Weaver]

add on

I'm assuming that the other add on codes would be the 33517-33530 for the venous grafts and arterial grafts combined. It would look something like
33533
+33517
+33508

If this is what it looks like, then it's correct. The endoscopic harvest would cover the 33517 venous grafts.