Anesthesia Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: Some of the surgeons in our hospital have begun performing coronary artery bypass graft (CABG) surgery without the pump instead of with it. Can you tell me more about this, and how our reimbursement will be affected?

Pennsylvania Subscriber



  Answer: Report the procedure (both the CABG and the mini-sternotomy CABG) using CpT 00560 (anesthesia for procedures on heart, pericardium, and great vessels of chest; without pump oxygenator) or 00562 (anesthesia for procedures on heart, pericardium, and great vessels of chest; with pump oxygenator). The anesthesia providers involvement in the procedure is the same whether the pump is used or not. The base units for your reimbursement, however, are not the same.

CABG can be performed two ways: with or without a pump oxygenator. This pump oxygenator is the heart-lung machine that keeps the patients blood flowing to the brain and other organs while the heart is stopped during CABG surgery. In cases when the pump is not used, the heart is not completely stopped. This is a new approach to CAGBs that saves the patient several risks and includes benefits such as quicker recovery time. Some hospitals, such as Loma Linda University in California, also are performing mini-sternotomy CABGs, which is the same procedure with endoscopic instruments. Again, this has advantages for some patients since the healing time is shorter since there is less incision and less sternal wiring.

The American Society of Anesthesiologists (ASAs) base value for 00560 without the pump is 15; the base value for 00562 with the pump is 20. This difference in base units will affect your reimbursement. Medicares resource-based relative value system (RBRV) also assigns these same base values to the procedures, but other carriers may have their own base units that providers should use. Always verify what base units the patients carrier requires before filing the claim.

If the carrier will accept ASA codes, the 2000 guide has added 00565 (with a base of 25 units) for CABG performed without the pump. Some carriers may not accept this code because it is not in CPT Codes , so be sure it is accepted before filing with it.

Performing the procedure without the pump is becoming more common, so you no longer can assume 00562 automatically applies. Its always important to code procedures correctly, but especially in situations when the base units are different. Be sure you know which procedure is performed with or without [...]