vinomodyjr
Networker
CCVTC Cardiovascular and thoracic surgery coding
A method for Coronary artery bypass grafting (CABG) for severe coronary artery disease is presented based on a case from 2016-2017 AHA Coding Clinic ICD-10-CM/PCS and HCPCS subscription. The relative value units were based on 2017 National Physician Fee Schedule Relative Value File January Release.
Case
A 55 year old patient with type 2 diabetes mellitus and a smoker was admitted for coronary artery bypass graft (CABG) for treatment of severe coronary artery disease. He had symptoms of unstable angina including worsening chest pain and dyspnea. He also has significant peripheral vascular disease. Before CABG operation, patient underwent left and right heart catheterization including left ventriculography and coronary angiogram which showed 95% occlusion in the left anterior descending artery, 100% stenosis of the posterior descending artery, 90% occlusion in the diagonal artery, and 97% occlusion of the obtuse marginal artery. Ventriculography showed the heart to be of normal contractility with no dilation or dyskinetic action and with an ejection fraction of 65%.
Place of service: Hospital B
Surgeon: Dr. D
Assistant surgeon: Dr. B
Preoperative diagnosis: Coronary artery disease
Postoperative diagnosis: Severe coronary artery disease with > 90% occlusion in LAD, posterior descending artery, diagonal artery, and obtuse marginal artery
Operation: Aortocoronary bypass grafting times four with implantation of left internal mammary artery (LIMA) and left anterior descending (LAD) coronary artery; Separate saphenous vein bypass graft from the aorta to the posterior descending artery, obtuse marginal artery, and diagonal artery; endoscopic vein harvest.
Method
Determine whether the coronary bypass is venous grafting only, combined arterial-venous grafting, or arterial grafting only. Determine the number of venous and arterial grafts in a matrix. Determine the overall CPT codes for the case.
Matrix
Grafting
- Posterior descending artery (a branch of right coronary artery)
Saphenous vein- Obtuse marginal (a branch of left circumflex artery)
- Diagonal (a branch of left coronary artery)
LIMA- LAD
Vino C. Mody Jr., COC, CPC, CCS-P, CANPC, CCVTC
Codes
33533, 93460, +33519, +33508, I25.110, E11.51, F17.200
Relative value units, used in CPT coding to determine rank order of CPT codes (highest RVU is listed first)
93460, RVU=34.13
33533, RVU-54.22
33519, RVU=15.83
33508, RVU=0.47
In this case, there is combined arterial and venous grafting. There are 3 venous grafts and one arterial graft. The patient underwent endoscopic vein harvest of the saphenous vein. The patient has atherosclerotic heart disease of native coronary artery with unstable angina pectoris. The patient has type 2 diabetes mellitus and is a smoker, which increase the chance of developing coronary artery disease. He also has peripheral vascular disease which is reflective of atherosclerotic vessel disease peripherally in this case of severe coronary artery disease requiring four-vessel CABG.
A method for Coronary artery bypass grafting (CABG) for severe coronary artery disease is presented based on a case from 2016-2017 AHA Coding Clinic ICD-10-CM/PCS and HCPCS subscription. The relative value units were based on 2017 National Physician Fee Schedule Relative Value File January Release.
Case
A 55 year old patient with type 2 diabetes mellitus and a smoker was admitted for coronary artery bypass graft (CABG) for treatment of severe coronary artery disease. He had symptoms of unstable angina including worsening chest pain and dyspnea. He also has significant peripheral vascular disease. Before CABG operation, patient underwent left and right heart catheterization including left ventriculography and coronary angiogram which showed 95% occlusion in the left anterior descending artery, 100% stenosis of the posterior descending artery, 90% occlusion in the diagonal artery, and 97% occlusion of the obtuse marginal artery. Ventriculography showed the heart to be of normal contractility with no dilation or dyskinetic action and with an ejection fraction of 65%.
Place of service: Hospital B
Surgeon: Dr. D
Assistant surgeon: Dr. B
Preoperative diagnosis: Coronary artery disease
Postoperative diagnosis: Severe coronary artery disease with > 90% occlusion in LAD, posterior descending artery, diagonal artery, and obtuse marginal artery
Operation: Aortocoronary bypass grafting times four with implantation of left internal mammary artery (LIMA) and left anterior descending (LAD) coronary artery; Separate saphenous vein bypass graft from the aorta to the posterior descending artery, obtuse marginal artery, and diagonal artery; endoscopic vein harvest.
Method
Determine whether the coronary bypass is venous grafting only, combined arterial-venous grafting, or arterial grafting only. Determine the number of venous and arterial grafts in a matrix. Determine the overall CPT codes for the case.
Matrix
Grafting
- Posterior descending artery (a branch of right coronary artery)
Saphenous vein- Obtuse marginal (a branch of left circumflex artery)
- Diagonal (a branch of left coronary artery)
LIMA- LAD
Vino C. Mody Jr., COC, CPC, CCS-P, CANPC, CCVTC
Codes
33533, 93460, +33519, +33508, I25.110, E11.51, F17.200
Relative value units, used in CPT coding to determine rank order of CPT codes (highest RVU is listed first)
93460, RVU=34.13
33533, RVU-54.22
33519, RVU=15.83
33508, RVU=0.47
In this case, there is combined arterial and venous grafting. There are 3 venous grafts and one arterial graft. The patient underwent endoscopic vein harvest of the saphenous vein. The patient has atherosclerotic heart disease of native coronary artery with unstable angina pectoris. The patient has type 2 diabetes mellitus and is a smoker, which increase the chance of developing coronary artery disease. He also has peripheral vascular disease which is reflective of atherosclerotic vessel disease peripherally in this case of severe coronary artery disease requiring four-vessel CABG.