# 00563, Hypothermic Circulatory Arrest



## TammyW (Jul 9, 2012)

I am STRUGGLING with when to code hypothermic circulatory arrest (00563).   I  know my CPT coding is right on target ... but when reading the OP notes and having to cross to 00562 or 00563, I am tripping myself up.   I have an understanding of what each anesthesia code means.   How does your office KNOW when to bill 00563?   Are there indicators that I am missing?


Thank you for your help!   Tammy


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## JudyW (Jul 9, 2012)

TammyW said:


> I am STRUGGLING with when to code hypothermic circulatory arrest (00563).   I  know my CPT coding is right on target ... but when reading the OP notes and having to cross to 00562 or 00563, I am tripping myself up.   I have an understanding of what each anesthesia code means.   How does your office KNOW when to bill 00563?   Are there indicators that I am missing?
> 
> 
> Thank you for your help!   Tammy



Tammy,
Our anesthesiologists write in the anesthesia records that hypothermic circulatory arrest was done.  It should be in your physicians anesthesia record.  Ours will state the time it started and the time it ended.  Have you check the anesthesia records verses the OP report?  Hope this helps.


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## TammyW (Jul 9, 2012)

Hello Judy,   
We have discussed with the providers that they need to document clearly for us; I like your idea of having them indicate the start/end times.    I do compare the anesthesia and OP notes .. and it usually ends up that I'm clear from the anesthesia documentation and confuse myself with the OP note because the surgeon will mention hypothermia or the patient's core temperature.    
Thank you for your help!    Tammy


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## nlaaron (Sep 27, 2013)

so when the Surgeon indicates the body was cooled to 34 degrees celcius and is put on bypass, does that mean hypothermic arrest????


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## akay0809 (Nov 10, 2016)

I am doing some research on CPT code 00563 and found this thread.  I have a question also.  I work for a CVT surgeon who has ordered hypothermic arrest during a procedure and feels that he should be able to bill for this and be paid.  We have tried to tell him this is the only appropriate code for hypothermic arrest, but it is classified as an anesthesia code and he is not able to bill for it because the anesthesiologist does.  He is arguing that he should be able to bill for it.  Can you give me some direction on this?  Is there another code we should be billing for him?  Is he able to bill for this at all?  He mentions it in his operative report, but it is also documented in the anesthesia records.


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## combest (Apr 3, 2017)

Hello everyone, 

I am an anesthesiologist with significant cardiac anesthesia experience...I am also working towards CPC and own a medical billing company.  I learn so much here and humbly offer my clinical experience.  

All patients who are put on bypass (heart-lung machine) are cooled, usually to around 34 degrees.  this is to decrease the metabolism of the major organs, esp the brain, to tolerate the possibility of decreased delivery of oxygen to the organs.  Bypass, of course, is a circuit of tubing and a heart-lung machine that provides circulation of the patient's blood while the heart is stopped, making it much easier to work on.  

However, on rare occasions, it is necessary to additionally place a patient in deep hypothermic circulatory arrest (DHCA), often for surgery on the major blood vessels entering and exiting the heart:  aorta, superior venae cava, etc  The patients are heparinzed, put on bypass and cooled to 34.  Then, they are cooled down even more dramatically down to about 18 degrees, and then the bypass machine is completely STOPPED.  IOW, there is NO CIRCULATION AT ALL to the body since neither the heart nor the heart-lung machine are causing flow of the blood.  This is called "circulatory arrest."  The patients, are so cold that they can survive without blood supply, usually with the goal of 30 minutes or less before restarting blood flow via the bypass machine, then weaning off bypass to complete the surgery.  

So, as you can see, DHCA is a big deal.  Standard documentation on our records would note the start and stop time for Cardiopulmonary bypass, start and stop times for aortic cross-clamping, if appled, AND start and stop times for DHCA.  

I hope that is helpful.

https://en.wikipedia.org/wiki/Deep_hypothermic_circulatory_arrest


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