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Help coding CABG? 33533/33518

Coder708

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Dr states CABG X3.. I am only seeing 33533 & 33517 b/c of same vein.. Can anyone dissect this Op note for me an point out where the 3is coming from-- much thanks

ALso when a vein is in sequential fashion it only counts as 1 correct?

Right saphenous vain was harvested endoscopically. Sternotomy was made. LIMA artery was dissected. Pericardium was incised. The left anterior descending was stabilized and dissected. LIMA was anastomosed. Heart was elevated. The posterior descending was stabilized and dissected. The vessel was quite small unsuitable for grafting. The heart was displaced laterally. The terminal circumflex was stabilized and dissected. Saphenous vein segment was anastomosed. Circumflex marginal was stabilized and dissected. The vessel was quite small and unsuitable for grafting. The ramus intermedius was stabilized and dissected. In the atrioventricular groove the same saphenous vein segment was opened and anastomosed in a side-to-side diamond sequential fashion. The first diagonal was inspected. The vessel was diffusely diseased and quite small. Bypass grafting was deferred. The ascending aorta was opened with a Novare and closes. Proximal anastomosis device in the saphenous vein segment was anastomosed. There was excellent graft flow.. Incision closed in layers
 

toizd

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lima TO lad 33533
terminal circumflex and ramus intermedius 33518
making three bypasses
no, sequential grafts count
determine number by distal anastamoses
 
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