Vein to vein anastomosis in CABG

dhuston

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I'm new to this specialty and I'm trying to understand what's going on when the report says the aorta was punched and there was an end to end anastomosis of the vein. This is before they use the vein on the arteries being bypassed. Is there a code for this?

Thanks for your help!

Diane Huston, CPC
 

jewlz0879

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Hi Diane,

I code these regularly and I have never coded for that but the wording used seems a little different to me. I look for the vein graft and the anastomsis; which can be side-to-side or end-to-side. My physicians usually do these with the Sapehnous Vein and LIMA (Left internal mammary).
 

dhuston

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Thanks Julie. I'm not in the office so maybe I don't have the wording right. One more question...if they have to join two pieces of the vein to make one bypass graft, is there anything to code for the extra work of joining those two pieces?

Thanks for your help,
Diane
 

lisigirl

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Hi Diane,

I have found that when the vein graft is anastomosed to the aorta first, the procedure is usually being performed off cardiopulmonary bypass. That may be the case here and it is not coded any differently.

As for attaching vein to vein, you code your cabg based on distal anastomoses (contact points) where the bypass graft artery or vein is sutured to the diseased coronary artery. If the two vein grafts each have a contact point with a diseased coronary artery, I would count this as two bypass grafts. If only one of the veins is anastomosed to the coronary artery, this would count as 1 graft.

Does this make sense?

Lisi, CPC
eharkler@nmh.org
 
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