Wiki Femoral cutdown with CABG

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Physician performed femoral cannulation via left groin cutdown for cardiopulmomary bypass due to extensive scarring and adhesions around aorta. What is the correct billable CPT for the cutdown?

Your question response would be greatly appreciated!

Thanks, Sharon
 
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When the femoral cutdown is performed for CPB, I do not bill for this. Placing lines, putting the patient on bypass, etc. are integral parts of the main procedure and are therefore not separately billable.

However, if the repair of the artery is extensive, I would bill for this (35226, 35286).

Lisi, CPC

eharkler@nmh.org
 
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I have to disagree with you on that one Lisi.

36625 is billable with a CABG it does not bundle. My CVT surgeons rarely use this approach though. I don't bill it if they don't use it (ie they did the cutdown incase they needed it but ultimately didn't so they just close it up) but if they gain access and use it I bill for it.

Laura, CPC, CPMA, CEMC
 
I know that this code does not bundle in CCI but I've spoken with the STS about this and they confirmed, this should not be billed. It is one of those scenarios where Medicare would say, "you should have known this was an integral part of the procedure and regardless of bundling software, should not have billed it."

Another question for Sharon could be, what diagnosis are you linking to the femoral cutdown? If its the CAD, I again say don't bill this separately. Up to you though.

Lisi
 
lisigirl said:
I know that this code does not bundle in CCI but I've spoken with the STS about this and they confirmed, this should not be billed. It is one of those scenarios where Medicare would say, "you should have known this was an integral part of the procedure and regardless of bundling software, should not have billed it."

Another question for Sharon could be, what diagnosis are you linking to the femoral cutdown? If its the CAD, I again say don't bill this separately. Up to you though.

Lisi
Click to expand...

I have to add my 2 cents and agree with Lisi. If you are putting the patient on bypass how you get there is included. I do have surgeons who do this fairly often and I do not bill for a cut down. The CCI edits are not perfect and when it is an integral part of the procedure it is not billable.
Linda J King, CPC,CCVTC, CGSC
 
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