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  1. L

    Bronchoscopy and Thoracoscopy (31622 and 32666)

    I have always considered the bronchoscopy prior to a chest procedure to be included. As Yvonne said, the surgeons are most often performing this to get a "lay of the land" before proceeding with the primary procedure. The Society of Thoracic Surgeons advises that you do not bill a diagnostic...
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    Insertion of IABP through open axillary artery

    Do a lot of you find your physicians using the axillary artery to place an intra-aortic balloon pump? If so, what code are you using for this? thank you! Lisi
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    Status of three chronic conditions

    I just wanted to add my two cents :) I agree with Chelle that the status of the 3 chronic conditions need to be from the patient so you would expect to see subjective statements. For example, HTN has been stable per home BP checks. no CP. Taking meds daily. etc. However, IF a provider wrote...
  4. L

    Review of Systems - records and labs count

    no, think of a review of systems as a review of "symptoms." These are subjective statements from the patient (e.g., no chest pain, no SOB, no fever, etc). The provider is credited one point for ordering or reviewing a CT scan result under the data section of MDM. Or, if the physician personally...
  5. L

    Parietal pleural bx w/o thoracoscopy

    If the surgeon performed a VATs pleurodesis, just bill for that 32650. The biopsy of the pleura is incidental to that. Lisi, CPC
  6. L

    Cabg-Generally, what

    Those are the cabg codes but for an idea on reimbursement, I'd say the code combination I tend to bill the most is the following: 33533, 33518, 33508 or 33533, 33519, 33508. I see a lot of 3 and 4 vessel cabg procedures and for the most part, my surgeons use the LIMA and then the rest are vein...
  7. L

    Vein Harvest

    I know, the CPT book didn't do the best job of explaining the vein harvest. I know the instructions you are talking about that state the procurement of the saphenous vein is included however, in the book, right before that paragraph, is the code 33508. The description of which is "Endoscopy...
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    if he did the cannulation just to put the patient on bypass, you would not charge separately for this. Lisi, CPC
  9. L

    Type A aortic dissection

    I think CPT 33860 is the only code you would use. I'm not even sure how a 22 modifier would be appropriate. What is not being accounted for by billing code 33860 alone? Maybe I am just missing something :) Thanks, Lisi, CPC
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    Pulomonary Decortication/Right, Flexible bronchoscopy, Right Thoracoscopy/thoracotomy

    I don't have info on this procedure specifically. I tell all new cardiothoracic coders that I highly recommend going to the annual STS Coding workshop. Every year it is in a different location, this Nov it will be in Florida. I've been coding CT surgery for 8 years and I always leave the...
  11. L

    ECMO decannulation

    Julie, I bill for the repair of the blood vessel (ie: 35226), in fact, I am coding one right now - ha! Like you, I got this info from the STS. I agree that billing 33977 would be over-coding. Removal of an actual ventricular assist device often requires repairing holes in the heart, that is...
  12. L

    Pulomonary Decortication/Right, Flexible bronchoscopy, Right Thoracoscopy/thoracotomy

    I would code 32320 and 31645. The surgeon performed a therapeutic aspiration of the bronchus to remove the thick purulent secretions. The lavage part of this was just to help clear the secretions rather than to get a sample of lung tissue. This is why I chose 31645 rather than 31624. As for...
  13. L

    bronchoscopy-Can you code

    I agree, you can code 31633 multiple times. The descriptor states "...each additional lobe." As for the brushings and lavage, I would bill both as well however, payment will be reduced per "endoscopic payment rules" rather than the multiple procedure deductions. The value of the base code (in...
  14. L

    closure of empyema space - 32810

    Going by the titles only (and not the description of the procedure), I believe you would use CPTs 32810 and 15734 only. Lisi, CPC
  15. L

    Thoracotomy with decortication and drainage pleural space

    The note isn't the best because it is not clear if the surgeon decorticated the entire lung or just a portion of it. If it was my physician, I would have him clarify this in the note. I suspect this was a full decortication so the code would be 32220. Neither the drainage nor placement of chest...
  16. L

    TAVR Help!

    Hi, No, this would not be a transaortic approach. The surgeon must make a small incision (sternotomy, mediastinotomy) when performing the transaortic approach. Unfortunately, I don't think there is an established code for what your surgeon did. The arteries were too small for the sheath so they...
  17. L

    EKG preoperatively

    Hey Beth, If the surgeon did the EKG, then I agree that it is bundled. However, if it was done by another specialty, like cardiology, I would charge for it since the bundling only applies to the surgeon. Lisi
  18. L

    Robotic Thymectomy

    Hey Beth, I just sent you an email about this. I found your question because I was looking up the same question! too funny. I am going with CPT 32673 because the procedure is still minimally-invasive. Lisi, CPC
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    HELP 31624 Denial

    So you're not billing anything but 31624 and insurance is denying the entire claim stating it is bundled? If that is the case, I would call the payer about that. However, if you're billing multiple bronchoscopy codes at one time, the payer may be following endoscopic payment rules. CPT 31622...
  20. L

    Mitral Valve repair w/Ring

    or 33427. If all the surgeon did was place a ring, then it is 33426. If there was any reconstruction done (ie: plication or moving leaflets), then it would be considered complex and you should use 33427. Lisi, CPC
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    Hi, I would code 15734 & 21750. Diagnosis codes 998.31 & V45.81. The chest tubes are included. Let me know if you have any questions. Lisi, CPC
  22. L

    Thorascopic evacuation and decortication

    Others may disagree with me but I think I would just code the 32652. The primary procedure was the decortication (which is a surgical procedure for empyema) and since the surgeon was already in the chest cavity, it goes without saying that he is going to clean out the abscess cavities as well...
  23. L

    Ruptured Arch Aneurysm

    Look at CPT 33870 for the arch and then 33511 for the cabg. Let me know if you have any questions about this. Oh, if the surgeon performed an endoscopic vein harvest for the cabg, you can also bill 33508. I don't remember seeing it in the note below but I honestly just skimmed the...
  24. L

    Minimally invasive repair of partial anomalous pulmonary venous return.

    Is this Vickie? you sent this question to me directly last week. So sorry I haven't gotten back to you, I've just been swamped at work. Congenital coding really isn't my thing either so the codes don't just roll off my tongue :) I will look at your note today and get back to you at your email...
  25. L

    repair of right ventricular perforation;

    Are you sure the surgeon wants to charge for this repair? I ask because it sounds like it happened while opening the sternum so the surgeon may not want to charge for repairing it. If you are going to code this, I would look at 33300-33305. Lisi, CPC
  26. L

    Mitral Valve Leaflets Vegetations Biopsies

    Just code the MVR and cabg (33430, 33533) as you did. You wouldn't charge separately for the biopsies, if that is what you're asking. The surgeon had already removed the leaflets to replace the valve. Lisi, CPC
  27. L

    Procedures similar to TAVR (0256T)

    Hi Chrissy, You're about to get more info than you asked for. LOL! We priced these similar to 33405 as well but I can tell you that our Medicare provider (WPS) said they are reimbursing 0256T at 130% of allowable for 92986. We were part of the Partner trial so we've been doing this procedure...
  28. L

    STS Coding News Letter

    Hi Deb, Getting a response from Julie has become harder over the last 2 years. My guess is that the job is just too much for one person but still... I have emailed the coding help desk at (is that what you used?) and...
  29. L

    Replacement of ascending aorta with 22 mm Hemashield graft

    Hi, Let me know if you have specific questions but I would bill with the following codes: 33860 33870-59 dx: 441.01 I wouldn't code the repair of the arteries unless the repairs were complex (which I don't think these were but I need to add, by the end of this note I was just scanning it so...
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    TAVR 0256T Billing & Modifiers HELP - I am getting ready to submit

    At our practice, this procedure is done by a cardiac surgeon and an interventional cardiologist working together. We bill as co-surgeons, so 0256T-62. If the surgeon performs a cut down of the femoral artery (rather than percutaneous access), then I will bill 34812 under him alone (you cannot...
  31. L

    need a dx

    If it is proven to be a fibroelastoma, you can use 212.7. If it is not clear, then I have used either 424.1 or 786.6. Lisi, CPC
  32. L

    Repair aneurysm of CABG graft

    What did they do? If the surgeon performed another bypass, around the aneursym, use the CABG codes again. If the original surgery was more than 30 days prior, you can add CPT 33530. Lisi, CPC
  33. L

    Removal of ecmo cannulas

    Sorry, just getting back to this. I don't think it was an article from the STS, they said it at one of their annual coding workshops. If you think about it, I believe the documentation would support this. The surgeon opens up the artery and pulls the ECMO catheter out. You're not billing for...
  34. L

    Please to cardiothoracic

    If you can make it to the annual STS Coding Workshop in October, they always provide a ton of information. I always find it helpful. You can check their website for info - I've been coding CT surgery for 7 or 8 years now. Feel free to email me with questions as well. Lisi, CPC...
  35. L

    excision atrial appendage

    Currently there is no code for LAA ligation. The Society of Thoracic Surgeons has stated that this is included in all maze procedures and/or mitral valve procedures. If performed with a cabg or another cardiac procedure, you could add a modifier 22 if you have medical necessity to support it...
  36. L

    Robicsek weave for sternal dehiscence

    Yes, I think it would just be 21750-78. Lisi, CPC
  37. L

    modified maze vs. maze

    A modified maze is just pulmonary vein isolation. If the surgeon does more, for example, if he makes a connecting lesion to the mitral annulus, that would be a maze. Lisi, CPC
  38. L

    Re-Do Aortic Valve Replacement

    No, the explant is included in 33405. However, if the previous valve surgery was more than 30 days ago, you can also bill cpt 33530 for the redo sternotomy. Lisi, CPC
  39. L

    Transcatheter Aortic Valve Replacement (TAVR)CPT???

    As of January 2012, these codes DO allow for co-surgeons. Prior to this year, the MFSDB did not allow for the -62 modifier however, we were in the clinical trial and our Medicare medical director told us we could bill as co-surgeons - although its been a battle getting paid, we have had success...
  40. L

    32505 vs 32500

    Michelle, is your surgeon just taking a biopsy of lung infiltrates (32607) and doing a lymphadectomy? Because if the patient has a lung nodule rather than infiltrates, the argument can be made that removing the nodule is for diagnosis and treatment. If performed for treatment, you can bill...
  41. L

    Aortic root replace/reimplant coronary button

    agree. Re-implantation of the coronary buttons is included in 33863. Lisi, CPC
  42. L

    MV repair/MV replacement

    You can only bill for the more extensive procedure which would be 33430. If your surgeon performed a complex valve repair first (in other words, he did more than just place a ring, he plicated the annulus or moved leaftlets before placing the ring), then I would add modifier 22 to 33430. My...
  43. L

    Billing On Q pain catheter and nerve blocks

    I agree with above, pain management by the surgeon is included in the global. I've been told by my surgeons that this isn't much work and takes like 3 minutes to do (and I have heard others surgeons at the STS say the same thing). You would need to bill with an unlisted code, if billing a...
  44. L

    Thoracoscopy w/ lysis of adhesions

    With regards to the first post, I'm pretty sure you can only bill for a diagnostic VATS - 32601- because there is no code for a VATS pneumolysis except when performed with a total decortication. If significant effort/work was involved to take down the adhesions, I would add modifier -22 to...
  45. L

    pulmonary: multiple biopsies, transbronchial and endobronchial

    Those are the codes I would use. You may need to add modifier -59 to 31625, I think it bundles to the transbronchial biopsies but since it was in a different part of the lung (the main carina), I think you can justify billing it. Lisi, CPC
  46. L


    I don't think there is specific code if they are making the annulus smaller by plicating the non-coronary sinus, I think you would just use 33405. If they were enlarging the annulus, I would use 33411. Lisi, CPC
  47. L

    Help with hemi aortic arch repair

    No problem. I've been lucky enough to attend the STS coding workshop every year for the last 6 yrs so I think I have a pretty good handle on this stuff :) Lisi, CPC
  48. L

    Help with hemi aortic arch repair

    I actually have to disagree. I think I would bill 33870-52. I am the first one to tell you that you can't use 33870 for a hemiarch but I don't think you have a choice here. The graft stopped proximal to the descending aorta so it did not include this, therefore, I think 33875 would be...
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    I would say if the patient was brought back to the OR to do this then absolutely you can bill for it. If it was bedside, it will depend on the payer. You cannot bill for bedside procedures in the global period if the patient has Medicare. If the patient has commercial insurance, then I'm a...
  50. L

    Total aortic arch replacement

    Your question doesn't make sense to me. LOL. I'm pretty sure this was a valve-sparing aortic root remodeling procedure because they placed a graft in the aortic root and then resuspended the native aortic valve in it. I don't understand what you mean by "coronary artery/vascular graft."...