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 indicates that you may report 35572 with CABG codes 33510-33523 and 33533-33536.

Tip: Let the physician know that describing where he harvested the segment from allows you to code properly and obtain maximum ethical reimbursement.

Learn 33517-33523 Rules for Arterial-Venous Coding

When a physician uses veins and arteries together to bypass an occlusion choose your code from 33517-33523 (Coronary artery bypass using venous graft[s] and arterial graft[s] ...).

Again you should not separately report the harvesting of the saphenous vein graft but you may report harvesting an upper-extremity vein with 35500 or harvesting a femoropopliteal vein segment with 35572.

Caution: CPT instructs you not to use codes 33517-33523 alone. Instead: Report both the arterial-venous graft code (33517-33523) and the appropriate arterial graft code (33533-33536 Coronary artery bypass using arterial graft[s] ...).

Example: The physician performs a bypass graft using one artery and two veins harvested from a lower extremity.

Solution: In this case report 33533 (Coronary artery bypass using arterial graft[s]; single arterial graft) and 33518 (Coronary artery bypass using venous graft[s] and arterial graft[s]; two venous grafts [list separately in addition to code for arterial graft]) Johnson says.

Report harvesting the femoropopliteal vein segment with 35572.

You may also append modifier 80 (Assistant surgeon) to the appropriate code (33517-33523 or 33533-33536) if a surgical assistant procures the arterial or venous grafts says Anne Karl RHIA CCS-P CPC coding and compliance specialist for St. Paul Heart Clinic in Mendota Heights Minn.

Special Notes for 33517-33530

Don't: Avoid the urge to append modifier 51 (Multiple procedures) to codes 33517-33530. CPT designates 33517-33523 as modifier 51 exempt and +33530 (Reoperation coronary artery bypass procedure or valve procedure more than one month after original operation) is an add-on code and therefore isn't subject to multiple-procedure rules.

Do: You should list 33530 separately to garner payment for the increased difficulty the physician faces when redoing a procedure. Report 33530 with CABG procedures 33510-33536.

Turn to 33533-33545 for Arterial Grafting

Finally you should report arterial bypass grafts using 33533-33536 (Coronary artery bypass using arterial graft[s] ...).

As with the other CABG codes if the physician harvests an upper-extremity artery such as the radial artery you may report this separately with 35500. And you may report 35572 separately for the harvesting of the femoropopliteal vein segment.

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