Wiki Coding separately for cannulation of lower extremities

[lydiachitwood]

Hello,
Has anyone heard of coding for cannulation of the femoral artery in addition to coding a cardiac surgery?
I have a case where the surgeon performed an aortic arch reconstruction. He mentions in the report that he cannulated the patient from the femoral artery. The surgeon says he was told that this can be coded and reimbursed separately from the main procedure.

Another surgeon told me that it does not matter where the patient is cannulated, that cannulation is inherent in surgeries that require the patient to go on cardiopulmonary bypass.

Does anyone know which is correct and could you refer me to anything in writing???

Thank you!!!

 

[ABridges]

Cannulation is not bundled in with the main cardiac CPT codes and can be billed using CPT 36620. (Assuming proper documentation is included in the OP note)

You can refer to the NCCI edits to determine which codes should be bundled.

 

[lydiachitwood]

This is very interesting, but confusing me a little. Because when a patient is put on CPB I thought that the surgeon places a cannula in the right atrium, vena cava, or femoral vein to withdraw blood from the body. The cannula is then connected to tubing filled with isotonic crystalloid solution. Venous blood that is removed from the body by the cannula is filtered, cooled or warmed, oxygenated, and then returned to the body. The cannula used to return oxygenated blood is usually inserted in the ascending aorta, but it may be inserted in the femoral artery.

So, in the detailed description of a large majority of cardiac cases, it will state the patient is put on CPB before the procedure is done. Also, certain CPT code descriptors state procedures either on CPB or without.

How could I code for cannulation if its detailed in the procedure? And, how could I appeal, without any documentation, that this is correct coding?

Thank you for your help, I must show proof to my surgeons.

 

[lydiachitwood]

still need help

In the 2004 STS newsletter (still current per Julie Painter Sep 17, 2012) it states that intra-operative services included in the cardiothoracic surgical package include "insertion of lines/catheters/cannulas for access or monitoring purposes (e.g., Swanz Ganz catheter insertion, arterial line insertions)".

Does anyone have a thought as to how I code code for cannulation from the femoral or carotid arteries and receive payment?