Cardiology Coding Alert

Answer: According to CPT 2002, you should select the code that accurately identifies the service or procedure performed. "Do not select a CPT code that merely approximates the service provided. If no such procedure or service exists, then report the service using the appropriate unlisted procedure or service code," CPT states.

Consequently, you should report this procedure using 33999 (Unlisted procedure, cardiac surgery). You should attach the operative report and a letter detailing in lay terms what the procedure entailed to the claim to illustrate clearly what the procedure involved.

The letter should include an adequate description of the nature, extent and need for the procedure, as well as the time, effort and equipment necessary to provide the service, according to CPT. Additionally, you may include the complexity of symptoms, final diagnosis, pertinent physical findings, diagnostic and therapeutic procedures, concurrent problems, and follow-up care.