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Endoscopic vein harvest CABG - questions

  1. Question Endoscopic vein harvest CABG - questions
    Medical Coding Books
    I have an RN who has started to endoscopically harvest the saphenous vein under the supervision of the surgeon. From searching older posts on the aapc website, it appears I can bill 33508 for the surgeon even though he isn't doing the harvesting of the spaheous vein, is that correct? I'm thinking I should be able to bill for the RN or PA if the insurance allows it with a 80 modifier also. Have not billed 33508 yet, wasn't sure if I could as the RN/PA is doing the work. Just a little hesitant to bill so, need clarification.


  2. Default
    CPT modifiers -80, -81 and -82 are used for surgeons.

    CPT modifier -80 can be billed by a NP/PA if he/she is billing with their own provider number as an assistant surgeon.

    HCPCS Level II modifier -AS represents the non-physician assistance at surgery.

  3. #3
    Columbus, Ohio
    We have a new PA with our practice, and I'm not sure how to bill a consult. Can you possibly advise if the PA does a consult (it also states in the consult "Please note that the consult was completed after the patient was seen and examined by ....) if the modifier AS should be used. Thanks for your input!

  4. Default
    Medical consults are usually done by Board Certified Physicians in Specialties, so since a PA is a Physician Assistant, I would not bill for a consult for a PA.

  5. Default
    Thanks for the modifier info. What I am really questioning though, is it correct to be billing 33508 for the surgeon? For example, if the patient has Medicare, and my RN does the endoscopic vein harvest, I know I can't bill and RN assistant to Medicare, but is it appropriate to still bill 33508 under my surgeon along with the CABG codes?

    I apologize that I was not clear enough in my initial question. Crazy day, sorry I'm slow on my response.

    I'd appreciate any advice on this coding scenario.

    Deb H.

  6. Default
    I would bill 33508 for the surgery as long as the surgeon was in direct supervision of the procedure and it was well documented for medical necessity. Regardless if the Registered Nurse First Assistant(RNFA) harvested the vein, she/he is exactly what her title says, "Assistant", meaning that she/he is there to assist the surgeon with procedures even if she/he does a procedure in whole or in part within her/his scope of practice.

  7. Talking
    Thanks so much for the clarification!

    Deb H.

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