Anesthesia Coding Alert

Question: My anesthesiologist began a bypass case without the pump oxygenator, then went on pump for the last hour. What’s the correct way to code this?

Arizona Subscriber

Answer: Usually, bypass cases begin without the pump oxygenator and move to on-pump. You typically report these with 00567 (Anesthesia for direct coronary artery bypass grafting; with pump oxygenator), unless the procedure involves both coronary and valve work. In that case, report code 00562 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator, age 1 year or older, for all non-coronary bypass procedures [e.g., valve procedures) or for re-operation for coronary bypass more than 1 month after original operation]) as instructed.

Working on a "beating heart" carries a greater risk. If the bypass is performed without a pump oxygenator (known as an off-pump bypass graft), report 00566 (Anesthesia for direct coronary artery bypass grafting; without pump oxygenator).

Tip: Remember these codes already account for complications represented by the qualifying circumstances add-on codes. Don’t include QC codes such as +99116 (Anesthesia complicated by utilization of total body hypothermia [List separately in addition to code for primary anesthesia procedure]) with codes for anesthesia during CABG procedures.