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CABG Coding

The heart muscle or the cardiac muscle is fed by coronary arteries. When these arteries get clogged with plaque or atherosclerosis, this is termed as arteriosclerotic coronary artery disease. ASCAD is characterized with the heart muscles beginning to execute at low levels (reversible ischemia) or actually die (irreversible ischemia) due to lack of blood. Reversible ischemia can be reversed if the normal blood flow is retained to the heart muscle, so that the heart muscle may begin to function at normal or near-normal levels.

Coronary artery bypass grafting is one way to increase the flow of blood. The diseased portion of the artery is bypassed by attachment of a healthy vessel above and below the diseased area. (Think of if it as a detour: the blockage in the artery is like a road block, and the bypass graft is like a car driving around the road block!). A healthy vessel is taken from elsewhere in the patient’s body. This is known as harvesting or procurement. The surgeon may harvest an artery, a vein, or both. The saphenous vein from the leg is one of the more common vessels harvested for use in bypass grafts.

To correctly code CABGs:

  1. Identify whether an artery, vein, or both are being used as the bypass graft
  2. Identify how many bypass grafts are being done.

CABG with Venous Grafting Only:

  • CABG with vein only, 1 graft – 33510
  • CABG with vein only, 2 grafts – 33511
  • CABG with vein only, 3 grafts – 33512
  • CABG with vein only, 4 grafts – 33513
  • CABG with vein only, 5 grafts – 33514
  • CABG with vein only, 6 or more grafts – 33516

**Remember, these codes are used to report CABG procedures using venous grafts only! If arterial grafts are also used, see codes 33517 – 33523**

Procurement of the saphenous vein is bundled into these codes and cannot be reported.

However, harvesting other veins can be billed separately:

  • Any upper extremity vein (open) – 35500
  • Any upper extremity vein (endoscopic) – 33508
  • Femoropopliteal vein segment – 35572

REMEMBER – these are add-on codes and are modifier -51 exempt.

CABG with Arterial Grafting Only:

  • CABG with artery only, 1 graft – 33533
  • CABG with artery only, 2 grafts – 33534
  • CABG with artery only, 3 grafts – 33535
  • CABG with artery only, 4 or more grafts – 33536

Procurement of the artery is bundled into these codes and cannot be reported EXCEPT when an upper extremity artery (e.g., radial artery) is procured.

To report harvesting of upper extremity artery:

  • Harvest of extremity artery (open) – 35600 (mod -50 if bilateral)

REMEMBER – this code is modifier -51 exempt.

CABG with Venous and Arterial Grafting:

To report combined arterial-venous grafts, it is necessary to report two codes:
1. The appropriate arterial graft code:

  • CABG with artery only, 1 graft – 33533
  • CABG with artery only, 2 grafts – 33534
  • CABG with artery only, 3 grafts – 33535
  • CABG with artery only, 4 or more grafts – 33536

2. The appropriate combined arterial-venous graft code:

  • CABG using venous and arterial grafts, 1 vein graft – 33517
  • CABG using venous and arterial grafts, 2 vein grafts – 33518
  • CABG using venous and arterial grafts, 3 vein grafts – 33519
  • CABG using venous and arterial grafts, 4 vein grafts – 33521
  • CABG using venous and arterial grafts, 5 vein grafts – 33522
  • CABG using venous and arterial grafts, 6 or more vein grafts – 33523

This code series 33517 – 33523 can NEVER be billed alone. These are add-on codes to the arterial grafting codes, 33533 – 33536. (Therefore 33517 – 33523 are modifier -51 exempt)

Procurement of the artery is bundled into these codes and cannot be reported EXCEPT when an upper extremity artery (e.g., radial artery) is procured.
Procurement of the saphenous vein is bundled into these codes and cannot be reported. However, harvesting other veins can be billed separately

To report harvesting of upper extremity artery:

  • Harvest of extremity artery (open) – 35600 (mod -50 if bilateral)

To report harvesting other veins that can be billed separately:

  • Any upper extremity vein (open) – 35500
  • Any upper extremity vein (endoscopic) – 33508
  • Femoropopliteal vein segment – 35572

REMEMBER – these codes are modifier -51 exempt.

+ 33530 – REOPERATION, CABG or valve procedure, more than one month after original operation.
This code is used to describe the extra work involved and increased difficulty involved with the reoperation. If physician indicated “reoperation” CABG (or valve procedure), use this code in addition to 33400 -33496, 33510 – 33536, 33863.

CPT Assistant:

“When performing a “redo” operation, a repeat sternotomy is performed. This requires removal of previously placed wire sutures, which may have become embedded in the bony portion of the sternum. The anterior cardiac chambers, great vessels and other mediastinal structures may be densely adherent to the posterior table of the sternum, so the sternal incision must be made with extreme care so as to avoid potentially catastrophic hemorrhage. Once the mediastinum has been entered, the scarring and adhesions from prior surgery may obscure the anatomic landmarks and make dissection both difficult and hazardous. Code 33530 is intended to describe this increased technical difficulty associated with the reoperation”

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