Check Your Coding Knowledge of Cardioplegia Medication in CABG Procedures
Question: A patient’s record includes the following documentation: Appropriate consent obtained; patient transferred to the operating room. Patient placed on the table, intubated, and general anesthesia administered. Transesophageal echocardiography performed, revealing aortic regurgitation and normal pathways. Preparation completed; left internal mammary artery [LIMA] harvested from the patient’s left lower leg. The greater saphenous graft was harvested. Pericardium opened; ascending aorta palpated and found to be soft, without calcification. Patient heparinized and cannulated via ascending aorta and right atrium. Cardiopulmonary bypass initiated; temperature allowed to drift. Both antegrade and retrograde cardioplegia catheters inserted. Target vessel suitable for bypass identified. Patient stable on bypass; aorta cross-clamped and heart arrested with 900 mL antegrade blood cardioplegia, 300 mL retrograde blood cardioplegia. Cardioplegia redosed as needed during procedure. Bypass completed from obtuse marginal [OM] branch of left circumflex with saphenous vein graft (end-to-end side fashion). Attention turned to left anterior descending artery [LAD]; LIMA used for bypass (end-to-end fashion). Anastomosis performed; cross clamps removed. Patient weaned from bypass; chest closed. How do I code this scenario? Alabama Subscriber Answer: Cardioplegia is a solution administered to stop the heart during cardiac procedures. By limiting oxygen within the heart, it reduces harm caused by reduced blood supply during surgery. This process is essential in coronary artery bypass graft (CABG) procedures. Cardioplegia can be delivered in two primary ways: antegrade technique, where cardioplegia is inserted into the aorta' and retrograde technique, where cardioplegia is inserted into the coronary sinus vein. Important: Improper administration may result in heart damage due to ischemia. In this example, the appropriate CPT® codes would include 33533 (Coronary artery bypass, using arterial graft(s); single arterial graft), +33518 (Coronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (List separately in addition to code for primary procedure)), and +33508 (Endoscopy, surgical, including video-assisted harvest of vein(s) for coronary artery bypass procedure (List separately in addition to code for primary procedure)). CABG procedures are coded based on the type of graft used: for veins only, use CPT® codes 33510-33513 (Coronary artery bypass, vein only ...); and for arteries only, use CPT® codes 33533-33536 (Coronary artery bypass, using arterial graft(s) ...). For combinations of veins and arteries, use codes +33517-+33523 (Coronary artery bypass, using venous graft(s) and arterial graft(s) ...) for veins and codes 33533-33536 for arteries. In CABG procedures, cardioplegia is also referred to as a cold preserving solution or systemic cooling. It is a required component in all of the CABG procedures listed above. Bottom line: There is no separately billable CPT® code for cardioplegia, as it is included in the CABG procedure codes. Cristin Robinson, CPC, CPMA, CCC, CRC, CEMC, AAPC Approved Instructor,
Education Coding Consultant, Bristol, Tennessee
