Wiki Left atrial appendage resection and MV repair

[Libby A.]

Hello, hoping someone can provide some clarity.

My providers sometimes perform LAA resections at the same time as an MV repair. I have advised them that, per recommendation of the STS, LAA's are not separately billable with MV or Maze procedures. While CPT guidelines specifically say not billable with Maze, they make no mention of restriction with MV procedures.

My providers are adamant they should be able to bill LAA's separately during MV procedures despite the STS recommendation. I don't have access to the STS coding forums/help desk to be able to ask directly, so is there anyone who can help explain WHY no LAA with MV procedures?

Any help or resource info would be greatly appreciated, thanks in advance.

 

[rejenia]

Is this a resection or ligation, clip or plication the atrial appendage. I believe anything regarding the LAA is included in the mitral valve procedures as well as Maze and it must meet medical necessity if performed with a CABG or other cardiac procedures then you can use modifier 22. I don't think there is a specific code so you would have to use 33999 unlisted code, but if it's not to treat prevention of A-fib it doesn't meet medical necessity for Medicare.

Hope this helps

 

[Libby A.]

Hi rejenia, thanks for the reply. This is an LAAA resection. I'm familiar with the STS coding recommendations, what I'm hoping to gain is an understanding of the basis/reasoning against billing with MV's. I'm guessing it has to do with proximity to the MV or maybe it is a normal variant with MV's that does not represent enough significant additional work/complexity to warrant separate billing. I'm hoping for something concrete I can show my providers to help them better understand the recommendation because they are pretty adamant they should be able to bill separately.

 

[j.monday7814]

STS left atrial appendage

I believe the STS is stating that the left atrial appendage procedure is included in all Mitral valve and MAZE procedures because it is standard practice to ligate the LAA during those procedures therefore the work involved in performing it is automatically included. However, since it is not standard practice to do anything to the LAA during a CABG then it is separately billable with an unlisted code or modifier 22. And that's pretty much exactly what I would tell the physicians. The STS has access to more info than we do about bundling guidelines, RVU breakdown, etc. so I would follow their advice in this situation.