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Coding a CABG

twilson2

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Need some reassurance:

Operation: Coronary Artery Bypass Graft X2 with endovascular vein harvest, left internal mammary artery to the left anterior descending artery and saphenous vein graft to the ramus.

Would the codes be

33517, 33533 & 33508?

I just need reassurance that this is correct. If not what is correct?
Thanks!
 

heiditipherwell

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From the information that you provided, it sounds to me as if two grafts were done, the mammary and the saphenous, correct?
My only confusion after reading the guidelines for 33533 which covers the mammary graft, and code 33510 for the saphenous graft ( this code is not one that you listed in your original post), is that the guidelines for 33510 state that code may only be used for a bypass procedure using venous grafts ONLY. 33510 may not be used when performing arterial and venous grafts during the same procedure. So this leaves the question, how to report the saphenous graft?
Code 33533 covers arterial and venous, however the guidelines make no mention of the saphenous. However, my guess is this set of codes covers it and your code should be changed to 33534 to cover 2 grafts, instead of 33533 which is a single.
Hopefully I did not confuse the situation even further.
Good luck.
Heidi
 

dzanoni

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Those are the codes that I would and do use. The 33517 is the code for the saphenous vein used along with an arterial graft. It is an add on code, so you will not need to use a modifier. We get paid on this every time. The code 33534 is only used if you use two different arteries for the graft, which you didn't.
Hope that clear is it up for you.
Dawn
 

Anna Weaver

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Cabg

I agree with the codes also, 33517 and 33533 as this is combined, my question concerns the 33508. Would you use that with the saphenous and mammory? I know it's for endoscopic harvest of veins, but I thought the saphenous and mammory were inclusive. Is this not correct? Any help please?
 

dzanoni

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I use the 33508 when the saphenous vein is harvested endoscopically, and we are getting paid for it. I do not use it if the vein was harvested by open technique. I bill this code quite frequently.
 

Anna Weaver

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coding CABG

Thank you for explaining. I haven't been coding this at all because I was under the impression all the harvesting for saphenous was inclusive. I will keep my eye out for the endoscopy approach from now on. Thanks!
 

dpenning

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I use the 33508 when the saphenous vein is harvested endoscopically, and we are getting paid for it. I do not use it if the vein was harvested by open technique. I bill this code quite frequently.
I've been struggling with this as well. The add on code 33508 does not include 33533 in its list of primary procedures but as you say it is getting paid. My concern is that the payer will come back at a later date and say "oops, that shouldn't have paid". Do you have any concerns about the primary procedure?
 

Anna Weaver

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saphenous

I've been struggling with this as well. The add on code 33508 does not include 33533 in its list of primary procedures but as you say it is getting paid. My concern is that the payer will come back at a later date and say "oops, that shouldn't have paid". Do you have any concerns about the primary procedure?
I don't think it would list the 33533 as a primary, as it's a venous graft. The procedures listed with the 33508 are the venous grafts and venous with arterial grafts. I have been struggling as I said concerning this, but have found that they do this a lot endoscopically so I can code it. I haven't had a lot of feed back yet, we'll see.
 
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