General Surgery Coding Alert

Aorta coarctation repair marks additions for next year.

With new options for reporting services such as artery harvest for coronary bypass, aortic coarctation repair, and left atrial appendage (LAA) closure, vascular surgery coders have a lot to learn by the time CPT^® changes become effective on Jan. 1, 2022.

Read on for a breakdown of what you need to know for your surgery practice next year.

Clarify Artery Harvest for Bypass

Harvesting a vein or artery for a coronary artery bypass graft (CABG) is separately reportable in some cases. CPT^® 2022 makes some changes that will affect how you report these services

Upper extremity artery: Two changes affect how you’ll report an upper extremity artery harvest for CABG. First, revised code 35600 (Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, open) adds “open” to the code descriptor. CPT^® 2022 also removes the + designation and the parenthetic “(List separately in addition to code for primary procedure),” meaning that 35600 is no longer an add-on code. If the surgeon performs the procedure endoscopically instead of as an open procedure, you should turn to new code 33509 (Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, endoscopic).

Refresh instructions: CPT^® provides specific instructions about if and when you can separately code the vessel harvest in addition to a CABG procedure. The 2022 manual updates the instructions to accommodate code revisions.

Existing instructions direct you to first select the appropriate CABG code for venous graft (33510-33516), or arterial graft (33533-33536), or combined (arterial graft code plus +33517-+33523). Following the CABG code(s) selection, you should handle the vein or artery harvesting as follows:

• CABG includes saphenous vein harvest
• Upper extremity vein harvest earns an additional code: +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))
• Femoropopliteal vein segment harvest earns an additional code: +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))
• CABG includes artery graft harvest except for upper extremity artery (such as radial artery), which you can separately report.
• "CPT^® 2022 updates instructions to direct you to additionally report 35600 or 33509 for the upper extremity artery harvest depending on whether the procedure is open or endoscopic, respectively,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, billing specialty subject matter expert at Kareo in Irvine, Calif.

Find New Coarctation of Aorta Repair Choices

CPT^® 2022 adds the three new codes you can report for transcatheter interventions for revascularization or repair of coarctation of the aorta. Coarctation is a narrowing of the aorta, often in the aortic arch. The defect is present at birth, but depending on its severity, may not be apparent until later in life.

The three new codes are as follows:

• 33894 (Endovascular stent repair of coarctation of the ascending, transverse, or descending thoracic or abdominal aorta, involving stent placement; across major side branches)
• 33895 (… not crossing major side branches)
• 33897 (Percutaneous transluminal angioplasty of native or recurrent coarctation of the aorta)

When the surgeon uses stent placement to treat coarctation, turn to either 33894 or 33895, according to the CPT^® guidelines. “Look to see if the endovascular stent is placed across one or more side branches of the aorta to properly assign the new endovascular stent repair of coarctation of the aorta codes,” says Robin Peterson, CPC, CPMA, Manager of Professional Coding Services, Pinnacle Integrated Coding Solutions, LLC.

You should report 33897 when the surgeon dilates the coarctation via balloon angioplasty without stent placement.

Don’t miss: Codes 33894-33897 include many services that you cannot separately report, per the CPT^® guidelines, including:

• Fluoroscopic guidance of the intervention
• Diagnostic congenital left heart catheterization
• All catheter and wire introductions and manipulation
• Angiography of the target lesion

Focus New LAA Exclusion Codes

Because patients with atrial fibrillation are at increased risk of stroke from a blood clot that can potentially form in the LAA, blocking (excluding) the appendage is a common treatment for patients who cannot tolerate blood thinners. Clinicians may also request LAA exclusion to alleviate postoperative thromboembolic complications.

You’ll find several new LAA exclusion codes in CPT^® 2022, as follows:

• 33267 (Exclusion of left atrial appendage, open, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip))
• +33268 (Exclusion of left atrial appendage, open, performed at the time of other sternotomy or thoracotomy procedure(s), any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) (List separately in addition to code for primary procedure))
• 33269 (Exclusion of left atrial appendage, thoraco­scopic, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip))

Don’t miss: LAA exclusion procedures include methods to close off the appendage, such as stapling, oversewing, ligation, plication, or clip, per the CPT^® 2022 guidelines. Other methods may include blocking the LAA with an expanding device, such as the WATCHMAN™.