Cardiology Coding Alert

Resist the temptation to append modifier 51 to 33517-33523

If you're confused about how to report CABG procedures help is here. Focus on this error-prone code series get into the nitty-gritty of documentation and never append the inappropriate modifier again. Your CABG Code Depends on Graft Number Codes 33510-33545 describe venous and/or arterial coronary artery bypass grafting CABG. For the bypass the physician harvests healthy veins or arteries from other areas of the body. Patients may require multiple grafts--three to five are fairly common.

Reality: The difficulty of coding a CABG procedure often depends on the physician's dictation says Barbara Johnson CPC president of Real Code Inc. in Moreno Valley Calif.

 The physician will decide the number of artery bypasses and the number of vein bypasses based on the individual patient Johnson says. Explain to the physician that his report must clearly describe how many arteries and veins he used so that you may code accurately she says. Why: Your choice of a CABG code--and your reimbursement--depends on the number of grafts.

Example: Code 33510 (Coronary artery bypass vein only; single coronary venous graft) may pay $400 less than 33516 (... six or more coronary venous grafts).

Careful: If your physician fills out a worksheet for CABG procedures don't assume that sheet has all the information you need Johnson says. You should read the report to be sure you have the correct numbers for the artery and vein bypasses she says.

Tip: When you read the operative report underline or highlight the number of artery and vein grafts the physician completes Johnson says. Mark up a copy of the report and save the original in case a payer or auditor wants to review the patient's chart. Look to 33510-33516 for 'Vein-Only' Procedures The first CABG codes listed in CPT 33510-33516 (Coronary artery bypass vein only ...)--refer to venous bypass grafts. Instructions in the CPT manual tell you that these CABG codes include obtaining the graft from the saphenous vein which runs along the inside of the leg so you should not report the harvesting separately.

Good news: You may report harvesting an upper- extremity vein with add-on code +35500 (Harvest of upper-extremity vein one segment for lower-extremity or coronary artery bypass procedure). Because this is an add-on code you must report it with one of the codes designated by CPT including 33510-33536.

You may also separately report harvesting a femoropopliteal vein segment with add-on code +35572 (Harvest of femoropopliteal vein one segment for vascular reconstruction procedure [e.g. aortic vena caval coronary peripheral artery]). CPT [...]