Wiki Innominate Artery Cannulation via 10 mm graft with cardiopulmonary bypass separately billable?

[mrivera9186]

Patient presents for aortic root replacement, ascending hemi arch replacement, antegrade stent graft placement in the descending aorta, innominate cannulation, u/s guided placement of right CFA 5 french sheath. Provider billed 33405 (Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve), 33866 (Aortic hemiarch graft including isolation and control of the arch vessels, beveled open distal aortic anastomosis extending under one or more of the arch vessels, and total circulatory arrest or isolated cerebral perfusion), and 33999, unlisted procedure, cardiac surgery.

Upon review of the above, the provider is billing the unlisted code for the innominate artery cannulation via 10 mm graft, from here, the provider proceeded to connect that with the cardiopulmonary bypass machine. The question is, there is a CPT already billed that has "with cardiopulmonary bypass" in the code description (33405); is the innominate artery cannulation separately billable? The thought process is, if you must perform the innominate cannulation to get the patient on CPB, then it is included because the base code includes CBP.

The OP report reads: "The innominate artery was dissected out. The patient was fully heparinized and the 10mm graft was anastamosed to the artery. The innominate graft was de-aired and connected to the arterial CPB circuit."

 

[ellis3350]

You want to look at 34716 for the 10mm graft conduit creation for CPB. If the patient had an aortic root replacement, you would look at 33863. The 33405 is included. 33866 is an add-on code to 33858,33859,33863,33864, so if 33405 is correct for what was done, the 33866 isn't billable in this case. Hope this helps.