Single Vessel CABG

[cmacpc]

Dr. did a off pump single vessel CABG w/LT LIMA to LT LAD on beating heart.

TIA

[emoates]

33533 - bypass using arterial graft; single arterial graft.

[ABridges]

I agree with the 33533 code.

I would also add a 22 modifier to indicate the procedure was done off-pump. To be safe, I would send in a copy of the op note along with the claim.

[emoates]

Originally Posted by ABridges

I agree with the 33533 code.

I would also add a 22 modifier to indicate the procedure was done off-pump. To be safe, I would send in a copy of the op note along with the claim.

Alyssa

Do you know where I could find documentation that you can add a modifier 22 to indicate the procedure was done off-pump?

Erin

[ABridges]

Hi Erin,

I will look through my STS conference books when I get home. That was where I first learned to add a "22" to OPCABG.

I did find a couple of articles online that I will post on here until I can get the info from STS.

From www.articlesbase.com
An 'off pump' case takes place when the surgeon operates on the patient's still-beating heart. The physician is required to document 'off pump' before you can report the codes with higher base unit values. It can be worth approximately $85 more for an average Medicare case.


From www.prioityhealth.com:
Each procedure code has an expected range of complexity, length, risk, and difficulty. When the service provided exceeds these normal ranges (more complicated, complex, difficult, or requiring significantly more time than usual), add modifier 22 to the procedure code.

When use of modifier 22 is valid, an additional payment may be allowed. Additional payment consideration may not apply to every code paid. Additional reimbursement will be considered only when the documentation submitted clearly states the exceptional nature of the service provided.

[cmacpc]

Thank you for the info, sorry I was unable to reply sooner. We were assigned a project in our office & everything else was put to the side. I did have the right code but will add mod 22. Can you explain why they would do off pump vs pt on pump? I have been doing cardiothoracic for about 6 months now & am still trying to get a grasp on things especially when it comes to lungs, heart not to bad but lungs, wow especially with all the new codes that were bundled this year! Again thanks for your help

RMS

[helencombs]

I'd like to see documentation to support the use of mod 22. especially where it doesn't seem to take longer. cpt code doesn't specify on or off pump.

[emoates]

Originally Posted by ABridges

Hi Erin,

I will look through my STS conference books when I get home. That was where I first learned to add a "22" to OPCABG.

I did find a couple of articles online that I will post on here until I can get the info from STS.

From www.articlesbase.com
An 'off pump' case takes place when the surgeon operates on the patient's still-beating heart. The physician is required to document 'off pump' before you can report the codes with higher base unit values. It can be worth approximately $85 more for an average Medicare case.


From www.prioityhealth.com:
Each procedure code has an expected range of complexity, length, risk, and difficulty. When the service provided exceeds these normal ranges (more complicated, complex, difficult, or requiring significantly more time than usual), add modifier 22 to the procedure code.

When use of modifier 22 is valid, an additional payment may be allowed. Additional payment consideration may not apply to every code paid. Additional reimbursement will be considered only when the documentation submitted clearly states the exceptional nature of the service provided.

articlebase.com is referring to anesthesia billing and I know that it is more intensive for anesthesia when it is an off-pump case but I would still like to see documentation that this can be done for the surgeon as well.

[emoates]

I emailed Julie Painter at STS and received the following reply concerning the use of Modifier 22 on off-pump CABG's.

"It is not a given that the -22 modifier should be appended to the off-pump CABG cases. It would be determined on a case by case basis considering the work differential compared to the existing code. The entire global should be considered too, so maybe it takes a little longer to perform the procedure off-pump, but it might mean one less hospital or office visit during the global period. There is no given formula or criteria for when to use the -22 modifier, but a general consideration is that the case should represent 20% - 30% more work then the procedure to report the -22 modifier, which will probably not typically occur in the off-pump versus on-pump CABG codes. Also, the -22 modifier takes into account the total work effort, so not only a time differential, but also increased intensity, technical difficulty of procedure, severity of the patient's condition, physical and mental effort required, risk to patient and physician. The op note should reflect the increased work involved and some payers require a separate note supporting the increased work effort.

So bottom line, there may be cases where the -22 modifier is warranted for an off-pump CABG case, but it should not be used on all cases."

Hope this helps everyone who was questioning this.

Erin