CABG General coding question

jreavis

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I am new to heart coding and am so lost.

The procedures performed were
1. CABG x 4 (left internal mammary artery to left anterior descending artery and separate saphenous vein grafts to the first diagonal, the second diagonal and posterior descending arteries).
2. Endocascular harvesting of vein from right leg.

I understand that harvesting of the leg vein is bundled and can't be billed. I don't understand the coding for the CABG. I see that artery is being used for artery for the lad, however, what is confusing me is that veins were used to bypass arteries. I know I'm thinking this to death and it just can't be that hard. Can someone please help me?

I came up with 33533 and 33519, is this correct?
 
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CRC CPC

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I am new to heart coding and am so lost.

The procedures performed were
1. CABG x 4 (left internal mammary artery to left anterior descending artery and separate saphenous vein grafts to the first diagonal, the second diagonal and posterior descending arteries).
2. Endocascular harvesting of vein from right leg.

I understand that harvesting of the leg vein is bundled and can't be billed. I don't understand the coding for the CABG. I see that artery is being used for artery for the lad, however, what is confusing me is that veins were used to bypass arteries. I know I'm thinking this to death and it just can't be that hard. Can someone please help me?

I came up with 33533 and 33519, is this correct?
Just my opinion on what is listed here... 33533,33519,33508 like I said just my opionion :) the 33508 is for the endoscopic harvest of the vein, I hope this helps
 

lisigirl

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yes, I agree with the codes above. I just wanted to make sure you understand why 33519 was chosen, you sounded a little confused.

In a cabg procedure you are always bypassing a artery, the coding depends on whether you use vein to bypass the coronary artery or another artery.

Codes 33510-33516 are used when only vein is used for all bypass grafts. If the surgeon uses an artery to bypass a graft (such as the IMA), then you would use codes from 33533-33536 and, if in addition to this, vein grafts are done, you would also use codes in the 33517-33523 range.

The vein harvest is billable only when done endoscopically, which in this case it was.

Lisi, CPC
eharkler@nmh.org
 

jewlz0879

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Lisi,

Does it also have to say "endoscopic" vein harvest within the dictation? Or is it sufficient to just state "endocscopic" vein harvest under the "Procedures erformed?"

My doc is specifically stating "endoscopic" under 'Procedures Performed' yet in the dictation he just talks about harvesting and utilizing it.

Thanks~
Julie
 
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lisigirl

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Hi Julie,

It really should say it within the body of the op note. I have a surgeon that occasionally forgets to state 'endoscopic' within his note but he would document it in the title. I have been known to let this slide but my billing compliance dept confirmed with me that he really needs to say it within the body of the report in order to code for it.

Lisi, CPC
 

jewlz0879

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That is what I was told. I just wanted to make sure I was on the same page. I want to give it to him like you but, oh well. Thank you!
 
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