Wiki CABG with open vein harvest bilateral (not used for surgery) ??35682-52

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Clarksburg, WV
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Can someone please help me in determining if 35682-52 is the correct code for the open vein harvest on this procedure? I have the CABG coded as 33533, but the procedure also lists a saphenous vein harvest endo converted to open. the closest cpt i can find is 35682. Append -52 for reduced services.

Case is below with identifiers removed.

Thank you
INDICATIONS: an 85-vear-old gentleman who initially presented to the Hospital complaining of angina with

radiation of pain down his left arm. The patient presented with a STEM', was taken to the cath lab, and was noted to have significant

distal left main disease as well as ostial LAD disease. The patient was transferred to Regional for further evaluation.

The patient's past medical history is significant for advanced age, essential tremors, rheumatoid arthritis, hypertension, and dyslipidemia.

Risks, benefits, alternatives were explained to the patient as well as his wife and all questions answered. The patient agreed to undergoing

the following procedure.

FINDINGS: Transesophageal echo confirmed a starting EF of 65% with mild Al and mild MR. The patient was noted to have some calcium

located on his noncoronarv aortic cusp, however, the valve itself was opening without difficulties. Post revascularization, the patient's EF

improved to 75%.

The left internal mammary artervwas of good quality. Saphenous vein was attempted to be harvested from bilateral lower extremities

requiring endovascular vein harvest to be converted to open, however, upon retrieving vein from both of these legs, it was noted that the

vein in the calf was too small on scope, the vein that was removed from the open harvest of bilateral thighs also was too small and

unsuitable for utilizing for bypass grafting.

Due to the patient's extreme age and his culprit lesion, which was the left main and ostial lesion, discussion was made with th

patient's cardiologist, Dr. M, and it was decided to proceed with LIMA-LAD only. The patient is right dominant and his

lesions in his right coronary are amenable to PCI therapy. The decision was made to perform only the LIMA-LAD and Cardiology will

address his RCA as a staged procedure.

The patient was in sinus Brady atthe beginning of the case as well as coming off bypass. Therefore, a ventricular wire and ground wire

were placed, however, the patient did not require utilization at the end of the procedure.

DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position. After adequate

peripheral IV access obtained, the patient was induced under general anesthetic without anv difficulties. EVH was then performed with

conversion to open vein harvest of bilateral lower extremities. Please refer to findings for complete description ofthis procedure. The

incisions were closed with multilayer of running absorbable Vicrvl. Sternotomv was performed and the left internal mammary artery was

harvested in the pedicle fashion with care to protect the phrenic nerve. Heparin was then administered The patient was then cannulated

through the aortic root and right atrium and subsequently placed on cardiopulmonary bypass. The heart was initially arrested by 500 cc of

antegrade cardioplegia with good arrest.

The LAD was inspected. It was diffusely diseased requiring opening at the distal 3rd end of the A I mm probe was able to be

passed both proximally and distally at this site. The left internal mammary artery was then retrieved from the left chest and prepared in

usual fashion. Of note, there was good flow from the mammary artery. The LIMA-LAD anastomosis was then constructed in end-to-side

fashion with running 7-0 Prolene. Bulldog was removed. Once satisfactory hemostasis was noted, the fascia was tacked to the epicardium

with two 5-0 Prolenes. A Doppler was utilized, indicating excellent flow both in the mammary artery tself as well as distal to the


Cross-clamp was then removed. The heart regained spontaneous rhythm. After rewarming and reperfusion, the patient was successfully

separated from cardiopulmonary bypass with minimal inotropic support The patient was then decannulated Protamine was

administered. All cannulation and anastomotic sites were inspected and after confirming satisfactory hemostasis, 2 chest tubes were

placed, I in the left pleural space and I in the anterior mediastinum_ Additionally, a right ventricular pacing wire was placed as well as a

ground wire.

The sternum was then closed with heavy wire in subcutaneous tissue and skin with running Vicrvl. The incisions were cleaned and dried

and dry sterile dressings applied. The patient tolerated the procedure satisfactorily and was transported to the intensive care unit,

intubated and in stable condition.