Vein harvest for no apparent reason

LLovett

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I have an interesting op note that I would like to see if anyone else has ever had this come up.

This is the list of procedures:
1. Redo sternotomy
2. Replacement of aortic valve with 23mm mosaic bioprosthetic valve.
3. Replacement of the ascending aorta and proximal aortic arch with a 26mm Dacron tube graft.
4. Right upper lobe wedge biopsy of nodule.
5. Right endoscopic saphenous vein harvest.
6. Hypothermic circulatory arrest.

All of that was done and it took a long time, 6 page op note. The thing is they never intended to do and did not do a CABG. The op note clearly reflects VATS harvesting of the saphenous vein and that is the only time it is mentioned. Based on the note it was never used. When I code this out it ends up being
33863-22
32500-51
36625-51
33508

Problem is, there is no primary procedure for the 33508 to go with so it is kicking out in the edits. I will be talking to the surgeon about this case, but I just wanted to see if anyone else has ever had this type of situation.

Thanks for your input

Laura, CPC
 

lisigirl

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My surgeons, have on occasion, harvested the saphenous vein in case they needed to do a CABG. If they didn't end up doing one, I didn't charge for the vein harvest at all.

Oh, and you mentioned this was a re-do sternotomy. If the original procedure was a valve or CABG, you can bill 33530 also.

Lisi, CPC
 

LLovett

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Good catch on the re-do. I looked back thru his record and we have worked on a lung before but someone else did a CABG previously so that does apply.

Thanks!

Laura, CPC
 

krmichae

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It does not matter who did the first CABG. The code represents the extra work it takes to do a sternotomy on a patient who has had a prior surgery. Your physician should still bill the 33530.
 
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