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Thread: Cabg

  1. #1

    Default Cabg

    AAPC: Back to School
    I know this is simple. Must be the Friday and my brain cannot read anything else.

    OPERATIVE NOTE: Once the patient was brought to operating suite, he was
    prepped and draped in sterile fashion. Sternotomy was made. Both mammary
    arteries were taken down from the level of first rib to xiphoid. Endoscopic
    vein harvesting was completed. The RIMA was measured and sewn to the LIMA
    using 8-0 Prolene. The right mammary was used as inflow for the vein. The
    portion of the vein was not ideal, and we extended with an extra portion of
    right mammary to reach the PDA. Then, we were able to sublux the heart, it
    exposed the PDA. Initially, he did not tolerate manipulation of this vessel,
    and also we abandoned this approach. We then placed the LIMA to the LAD
    which improved his hemodynamics significantly. This was done with no snare
    and 8-0 Prolene suture in the Estech stabilizer. Then the PDA was completed
    with an extension graft. At this time, he tolerated the manipulation well,
    and finally the RIMA limb was placed to the OM. Once this was done, the
    flows were interrogated. There are satisfactory, and then protamine was
    administered. Once hemostasis had been achieved, the chest was closed in a
    standard fashion. As mentioned above, EEG had returned to baseline. SSEPs
    remained normal throughout the case. I was present for the entire duration
    of this operation.

  2. #2
    Join Date
    Apr 2007
    Richardson, TX


    I code these often and this one is a booger! I'm not sure this is 100% correct because the dictation kind of confuses me.

    LIMA to LD
    RIMA to OM
    RIMA to PDA

    Julie Graham, BA, CPC, CCC

  3. #3
    Join Date
    Apr 2007
    Richardson, TX


    Oops and 33508 for the vein harvest...
    Julie Graham, BA, CPC, CCC

  4. #4


    This dictation is definitely confusing but the way it reads now, I do not agree with Julie's codes. I believe all you would bill is 33535 for 3 arterial grafts (the 3 she listed below).

    It sounds as if (maybe) the RIMA was sewn to the vein graft to make it longer but I still think the contact point (the two vessels that were anastomosed) was the RIMA and PDA so the codes would stay the same.

    If you do not bill for a venous graft, you cannot bill the 33508.

    Lisi, CPC

  5. #5
    Join Date
    Apr 2007
    Richardson, TX


    Thanks Lisi. I couldn't tell if he used the venous graft or not. I can see what you are saying now.
    Julie Graham, BA, CPC, CCC

  6. #6


    Thanks so much. I did go with only 33535

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