Close left atrial appendage

jewlz0879

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Is there a code for capturing closure of a left atrial appendage using a 'clip' device?

I was hoping he did a limited MAZE however that is not the case or am I missing something. Please see below:

The patient was brought to the operating room and in the supine position, she
was placed under satisfactory double-lumen endotracheal anesthesia.
Prophylactic systemic antibiotics were administered and she was prepped and
draped in a sterile fashion. Now, in the left third intercostal space, at the
mid axillary line, a 5 millimeter port was placed and CO2 was insufflated.
Another 5 millimeter port was placed in the mid clavicular line, in about the
second intercostal space, and a larger port was placed down in the mid
axillary line at about the fifth intercostal space. This was enlarged so that
it would allow the clip to be introduced into the chest.

Now, with great care to preserve the integrity of the phrenic nerve and the
recurrent laryngeal nerve, I opened the pericardium posterior to the phrenic
nerve. A pericardial stay suture was placed in the anterior leaflet of the
pericardium, just posterior to the phrenic nerve, and this was lifted up and
brought out through the anterior chest wall to help protect the phrenic nerve
and to expose the left atrial appendage. Now, the clip was introduced through
the most caudad port site and it was manipulated around the atrial appendage
and down to the very base, where it was closed. There was good closure and
total occlusion of the atrial appendage.
 

lisigirl

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Hi Julie,

There is no code for ligation (clip) of the atrial appendage. When performed with a Maze procedure or a mitral valve procedure, this is included. If another cardiac procedure is done with this, such as a cabg, you can add modifier -22 to the primary procedure (when medical necessity supports billing for the ligation).

Due to the fact that there was no other procedure performed in this case, I think you need to use an unlisted code. Check with your surgeon regarding the fee, it might be a comparable to a pericardiotomy (33020).

Hope this helps. If anyone else knows of a code, I would be happy to know about it as well :)

Lisi, CPC
eharkler@nmh.org
 

jewlz0879

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Okay I had heard that as well but I've always been 'lucky' enough for it to be a MAZE. I've read and re-read this rpt, reaching. LOL.

I was afraid I'd have to use the unlisted. But hey, now I know. Unless someone else knows a better code. Thanks a million, Lisi!
 

alisac

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Stapling of Left Atrial Appendage

Is there a code for the stapling of a Left Atrial Appendage when performed with CABG/AVR with no mention of MAZE procedure. PLease advise

Alisa
CVS-VERO BEACH-FL
 

jewlz0879

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Some names you may see within the OP report: “LAA” aka atrial appendage ligation, plication or clip.
If an atrial appendage procedure is performed with cardiac procedure other than MAZE or Mitral valve, then if may be reported separately:
A) For removal of thrombus, use 33310/33315 (cardiotomy) and append modifiers 59 and the 51.
B) For other than thrombus removal, append the -22 modifier to the main procedure code or use the unlisted code, 33999 to report the atrial appendage procedure.
C) If the atrial appendage procedure is the only procedure performed, report the unlisted code, 33999.
• If the procedure is for prevention of a-fib (427.31), it does not meet medical necessity for Medicare and should not be reported.
• If it is done for treatment of chronic a-fib (427.31), then medical necessity would be met and you should report considering the criteria outlined above.


HTH
 

jewlz0879

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Some names you may see within the OP report: “LAA� aka atrial appendage ligation, plication or clip.
If an atrial appendage procedure is performed with cardiac procedure other than MAZE or Mitral valve, then if may be reported separately:
A) For removal of thrombus, use 33310/33315 (cardiotomy) and append modifiers 59 and the 51.
B) For other than thrombus removal, append the -22 modifier to the main procedure code or use the unlisted code, 33999 to report the atrial appendage procedure.
C) If the atrial appendage procedure is the only procedure performed, report the unlisted code, 33999.
• If the procedure is for prevention of a-fib (427.31), it does not meet medical necessity for Medicare and should not be reported.
• If it is done for treatment of chronic a-fib (427.31), then medical necessity would be met and you should report considering the criteria outlined above.


HTH
 

conleyclan

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Does anyone have a code that the 33999 can be mirrored to for pricing? I have to have this code set up and need to price it. Thanks.
Medicare does pay on category III codes, but it can be a struggle.
 

jbhansen

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West Wendover, NV
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Some names you may see within the OP report: “LAA� aka atrial appendage ligation, plication or clip.
If an atrial appendage procedure is performed with cardiac procedure other than MAZE or Mitral valve, then if may be reported separately:
A) For removal of thrombus, use 33310/33315 (cardiotomy) and append modifiers 59 and the 51.
B) For other than thrombus removal, append the -22 modifier to the main procedure code or use the unlisted code, 33999 to report the atrial appendage procedure.
C) If the atrial appendage procedure is the only procedure performed, report the unlisted code, 33999.
• If the procedure is for prevention of a-fib (427.31), it does not meet medical necessity for Medicare and should not be reported.
• If it is done for treatment of chronic a-fib (427.31), then medical necessity would be met and you should report considering the criteria outlined above.


HTH
Julie,
I find your information very helpful but I was wondering what your source was?
Thanks,
Jill Hansen, CPC
 
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Tiger Paw device

Has anyone ever coded for the Tiger paw device (ligation left atrial appendage)? We are having an issue with getting Medicare to the pay the claims. No all procedures are with Maze or CABG's. Please advise.
 
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