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Vein harvest for no apparent reason

  1. #1
    Default Vein harvest for no apparent reason
    Medical Coding Books
    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

    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

  2. Default
    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

  3. #3
    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.


    Laura, CPC

  4. #4
    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.

    Kristi Michaelson, CPC
    Coding & Compliance Coordinator
    Cardiothoracic Vascular Surgeons

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