I would personally bill the following codes:
33533-22 - LAD to IMA
33519-22 - vein grafts to circumflex, lateral, PDA
33508 - EVH
dx: 414.01, 511.0, 997.1
Although the surgeon needed to redo the grafts to the circ and lateral, I wouldn't code them twice. In the end, the surgeon had bypassed a total of 4 arteries. The -22 modifier is obviously supported by the adhesions and, maybe more so, by the severity of the patient's condition.
Is the -79 modifier added because the same surgeons did the carotid endarterectomy the previous day? because otherwise I don't understand why you used it (at my facility, vascular surgery would have done the endarterectomy and the cardiac surgeons would have done the cabg so I wouldn't need a modifier).
As for 33514, you can't bill that with 33533. You should only use that if only vein is used and the IMA was used in this case. I'm not looking at this as two separate surgeries, it was one case because the patient never left the OR.
Oh, i didn't add the -22 to 33508 simply because I didn't think the EVH sounded difficult but adding this or not to the add-on code may just be personal preference?
Hope my answer doesn't muddy the waters some more
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