Overview
This lecture covers CPT coding for coronary artery bypass graft (CABG) procedures, focusing on how to determine the correct codes based on graft types, quantity, vessel harvesting, and additional procedures.
What is Coronary Artery Bypass Grafting (CABG)?
- CABG involves grafting veins or arteries from other body sites to bypass blocked coronary arteries.
- Grafts are attached to the heart to reroute blood flow around blockages.
- Codes are determined by the number and type of vessels used as grafts, not the number of coronary arteries bypassed.
Key Coding Questions for CABG
- Determine if the grafts are arteries, veins, or both.
- Identify how many arterial and/or venous grafts are used.
- Decide if vessel harvesting is separately reportable.
- Check for any additional procedures performed during CABG.
Coding by Graft Type and Quantity
- Use venous grafting codes (33510–33516) if only veins are used.
- Use arterial grafting codes (33533–33536) if only arteries are used.
- For both, code arterial grafts first, then use add-on codes for venous grafts (33517–33523).
- Each code corresponds to the specific number of vessels grafted.
Harvesting Vessel Coding Rules
- Harvesting internal mammary, gastroepiploic, epigastric, and some other arteries is not reported separately.
- Harvesting upper extremity arteries (e.g., radial) is reportable with add-on code 35600.
- Harvesting saphenous veins is not reported separately; harvesting upper extremity vein (35500) or femoral-popliteal vein (35572) is reportable.
Co-Surgery Guidelines
- If one surgeon performs the bypass and another harvests the vessels, the assistant surgeon uses the same bypass code with modifier 80.
Additional Add-On Procedures
- Endoscopic vein harvesting for CABG is coded with add-on 33508 (use with specific CABG codes only).
- Coronary endarterectomy performed during CABG is coded per vessel as an add-on.
- Percutaneous insertion/removal of a ventricular assist device uses codes 33990–33997.
Practice Examples
- Example: Three arterial grafts (internal mammary); report 33535 (no separate harvesting code).
- Example: One venous (femoral-popliteal) and one arterial (epigastric) graft; report 33533, 33517 (vein add-on), and 35572 (vein harvesting).
- Example: One arterial, three venous grafts; saphenous vein harvested with endoscopy and endarterectomy performed; report 33533, venous add-on code, 33508 (endoscopy), and endarterectomy code.
Key Terms & Definitions
- CABG (Coronary Artery Bypass Graft) — Surgery to restore blood flow to the heart by bypassing blocked arteries.
- Add-on Code — A code used in addition to the primary procedure for related services.
- Saphenous Vein — Commonly used vein for CABG, not separately reportable when harvested.
- Endarterectomy — Surgical removal of plaque from an artery.
- Modifier 80 — Indicates assistant surgeon participation.
Action Items / Next Steps
- Write the four key coding questions in your CPT book.
- Highlight which vessels are included/excluded in specific codes for quick reference.
- Complete any assigned practice coding exercises.