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Epiaortic scanning with CABG

  1. Default Epiaortic scanning with CABG
    Medical Coding Books
    Our surgeons are wanting to bill for epiaortic scanning when performing CABG. We have been using CPT codes 37250/75945 and have been getting denials because the primary code isn't billed. We know which codes the primary codes are but the surgeons insist this is appropriate/medically necessary when they perform CABG. Due to the lack of information found on the web, I am hoping someone has some information that will clarify this for me.

  2. #2
    Richardson, TX
    37250/75945 is for IVUS - Intravascular Ultrasound.

    Epiaortic Ultrasound is - 76998-26. (I included this since the topic of this post is "epiaortic scanning," which to me, it not the same as IVUS.)

    Unless NCCI prevents IVUS from being billed with CABG (33510-33536) I don't see why it would be denied as CPT only states, "list in to code for primary procedure" and it does not designate "bill with XXXXX" as often times CPT does.

    Last edited by jewlz0879; 02-09-2013 at 10:24 AM.
    Julie Graham, BA, CPC, CCC

  3. #3
    Richardson, TX
    Epiaortic U/S – surgeon may bill, using 76998-26, if not billed by another physician (such as co-surgeon)
    Documentation of exam and indication required
    Surgeon must perform exam and provide the interpretation
    **Specifically denied for vein mapping
    Intraoperative Epiaortic U/S has shown to be superior to the palpation in evaluating the presence and extent of the atherosclerosis of the ascending aorta and aortic arch. In addition, specific modifications of the operative technique to avoid disrupting aortic atheromatous disease were proposed and reduced the evidence of interoperative stroke.

    TEE does not adequately visualize the distal ascending aorta and proximal aortic arch because of the tracheal air column, and Epiaortic U/S remains superior to the other currently available techniques.
    Julie Graham, BA, CPC, CCC

  4. Default
    We have been using the 76998 for the Medistim/graft patency which I dont think is correct but again I am having a hard time finding documentation to support this. I spoke with someone at the AAPC conference in Chicago and we were discussing this issue. She said that checking graft patency is inclusive to the CABG.

    Any thoughts on this?

  5. Wink Epiaortic ultrasound during CABG
    The answer to your question is in the CCI manual. This information is taken from the current manual:

    Revision Date: 1/1/2013
    CPT CODES 30000-39999

    D. Cardiovascular System
    1. Coronary artery bypass procedures utilizing venous grafts (CPT codes 33510-33523) include procurement of the venous graft(s) as an integral component of the procedure. CPT codes 37700-37735 (ligation of saphenous veins) should not be reported separately for procurement of the venous grafts.
    2. When a coronary artery bypass procedure is performed, the most comprehensive code describing the procedure should be reported. When venous grafting only is performed, only one code in the range of coronary artery bypass CPT codes 33510-33516 may be reported. No other bypass codes should be reported with these codes. One code in the range of CPT codes 33517-33523 (combined arterial-venous grafting) and one code in the range of CPT codes 33533-33536 (arterial grafting) may be reported together to accurately describe combined arterial-venous bypass. When only arterial grafting is performed, only one code in the range of CPT codes 33533-33536 may be reported.
    3. [B]During venous or combined arterial venous coronary artery bypass grafting procedures (CPT codes 33510-33523), it is occasionally necessary to perform epi-aortic ultrasound. This procedure may be reported with CPT code 76998 (ultrasonic guidance, intraoperative) appending modifier 59. CPT code 76998 should not be reported for ultrasound guidance utilized to procure the vascular graft.

  6. #6
    Default Tee
    What about a trans esophageal echocardiogram at time of CABG. Can the surgeon and a SA/PA for the vein harvesting

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