Wiki Chest Exploration post CABG

Create Wiki
J

jtb57chevy

Networker
Messages
75
Best answers
0
Will appreciate any help with this one.

Patient had CABG earlier in the day, crashed in the ICU and taken emergently to the OR for exploration. At the earlier procedure, patient had LIMA to OM2, RIMA to LAD and SVGs to OM1 and PDA. At the 2nd session, a new SVG to the LAD was done because the earlier graft didn't have good flow. The PDA also had suboptimal flow, so that SVG was moved to the RC.

Since this was a different session do I code the new SVG as 33510 or the add-on code 33517 since arterial grafts were used earlier? Also, is this type of scenario better described by 32120 or 35820? I know the 35820 is bundled with the CABG codes, but since there was no evidence of bleeding or tamponade is 32120 appropriate?

Thanks for any assistance!!!
 
jtb57chevy said:
Will appreciate any help with this one.

Patient had CABG earlier in the day, crashed in the ICU and taken emergently to the OR for exploration. At the earlier procedure, patient had LIMA to OM2, RIMA to LAD and SVGs to OM1 and PDA. At the 2nd session, a new SVG to the LAD was done because the earlier graft didn't have good flow. The PDA also had suboptimal flow, so that SVG was moved to the RC.

Since this was a different session do I code the new SVG as 33510 or the add-on code 33517 since arterial grafts were used earlier? Also, is this type of scenario better described by 32120 or 35820? I know the 35820 is bundled with the CABG codes, but since there was no evidence of bleeding or tamponade is 32120 appropriate?

Thanks for any assistance!!!
Click to expand...

You code a CABG based on the conduit used during the current procedure not what you did in an ealier proceudre. You can not bill 33517 unless it is billed with the primary procedure, so therefore the 33510-76 is the correct code. You can use 35820 on the same date of service if the patient left the OR, but is must be appended with a 78 modifier. I would not used 32120 since this does not apply to this scenario.
 
Last edited:
I didn't think it was appropriate to bill for moving the SVG to PDA graft higher up on the RC, since just 1 end of the graft was moved. Is that incorrect?

Thanks for the help with this. I'm pretty new to Cardiothoracic coding, so I'm still unsure about the complicated cases. I wish there were more educational resources out there. I went to the STS coding seminar this past November and it helped some. It would be nice if there were webinars that focused on specific areas for indepth education, like there are in the cardiology world.
 
Last edited:
A great resource would be the Dr. Z stuff; I've gotten his Surgery and Endovascular book, they are gold. Expensive, but worth it. Google Dr. Z.

Also Ingenix has a CT surgery book that might help.

HTH
 
I have not read the report, obviously, but I would not worry about the "session," I would continue to focus on the actual anastomosis and modifiers, when applicable.
 
You must log in or register to reply here.
Top