Anesthesia Coding Alert

Question: Can I code with both of the precise arterial and venous codes for a CABG (coronary artery bypass graft) case? I choose one code if the payer requires anesthesia codes. How should I code if the payer requires surgical codes?

California Subscriber

Answer: For CABG procedures, use this coding rule of thumb: Choose the most appropriate code to describe the procedure whether you're reporting anesthesia or surgical codes.

 If the CABG is arterial and venous, select from 33533-33536 (codes reporting the appropriate number of grafts for Coronary artery bypass, using arterial graft[s]). Other CABG codes include 33517-33523 for procedures using venous and arterial grafts, but these don't apply to anesthesia billing. Many coders generally use 33533 (... single arterial graft) if they don't know exactly how the procedure was performed. If the chart indicates a venous-only graft and you know the number of grafts involved, use the appropriate code from 33510-33516 (various numbers of grafts for Coronary artery bypass, vein only).

 Many coders report 33511 (Coronary artery bypass, vein only; two coronary venous grafts) if they don't know the number of grafts involved, because one bypass (33510, ... single coronary venous graft) is rarely performed unless a valve replacement or other cardiac procedure is done at the same session. Your best course of action is to call the surgeon's office to verify the procedure in order to code it correctly and to help speed up your payment.

 Appropriate anesthesia codes for these cases are 00560 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator), 00562 (... with pump oxygenator), 00563 (... with pump oxygenator with hypothermic circulatory arrest) and 00566 (Anesthesia for direct coronary artery bypass grafting without pump oxygenator).

 If you're coding for a Medicare patient, remember that you can't report 00563 because Medicare considers hypothermia to be part of a CABG and won't separately reimburse for it.