welcome my name is terry tropin and today i'm going to talk about cpt coding for coronary artery bypass grafts commonly referred to as cabbages first let me introduce myself i have a masters in healthcare administration informatics from the university of maryland global campus and have rhia and ccsp certifications also i'm an ahima approved icd-10 trainer i've taught health information technology at montgomery college for over 20 years i've also written books on coding these books are study guides that help summarize the confusing coding guidelines my books include one on e m coding one in icd-10-cm one on icd-10-pcs and another on external clause coding these are available on amazon if you enjoyed this video and i hope you do be sure to hit the like button and click on my picture at the lower right hand side to subscribe so what is a coronary artery bypass or cabbage veins or arteries are harvested from other sites in the body to use in coronary artery bypass they're taken from other places and used and grafted onto the heart the harvested blood vessels vessel is grafted the outside of the heart to bypass or going around an area of blockage such as for atherosclerosis a single vein or artery may be sutured at sites of disease to more than one coronary artery the important part to remember is the codes are determined by the number of vessels used as grafts the arteries and veins from elsewhere not the number of coronary artery vessels so here are the questions to the an overview of what i will be discussing in order to code for a cabbage you need to ask these questions did the graft include arteries veins or both how many veins or arteries were used is harvesting the vessels separately reportable what other procedures were performed i'm also going to talk about the guidelines for co-surgery in cabbage procedures and include some practice so the practice at the end of the video so let's discuss each question the first question concerns which vessels are in five involved arteries only veins only are both so if it's only veins you go to the section venous grafting only three three five one zero three three five one six if it's arteries only go to the section entitled arterial grafting three three five three three three three five three six if it is both you code first the arterial graft from these codes and then there is a separate section of add-on codes for combined arterial and venous grafting and that's three three five one seven three three five two three so let's the second question let's look at the second question how many venus and our arterial grafts were used so for arteries they're separate codes this is how many vessels so you have one artery two arteries three arteries four arteries three three five three three two three three five three six now if it's only veins you have separate set of codes and again it's one two three four five six beginning with three three five one zero two three three five one six so again if both arteries and veins are used in the grafting procedure two codes are required first a code from the artery and these are the ones we talked about before three three five three three two three six depending on how many and then you have an add-on code from a different section by the number of veins used again the add-on codes for veins also list specific numbers of vessels used so you have this is one this is two three four five so the next question is is harvesting the vessel separately reportable sometimes the harvesting procedure the obtaining the blood vessel to use in the grafting procedure on the heart sometimes it's part of the cabbage procedure and not reported separately but sometimes it can be reported separately so it's important to look at what's excluded and what's not first let's look at arterial grafts the guidelines state that harvesting of these vessels is part of the cabbage procedure and not coated separately so the internal mammary article artery also called internal thoracic artery um gastroepiplaic from the abdomen epigastric and some other side so these if this is the source of the grafting tissue don't report it separately but there are some that can be reported separately use a separate code an add-on code so upper extremity arteries three five six zero zero that can be reported separately so in this case one for the cabbage procedure and one for harvesting the artery obtaining the artery to use in the graft now there seems to be an inconsistency in the um guidelines so the introduction to the section for arterial grafting for coronary artery bypass bypass the first paragraph says the codes include the use of the internal mammary artery gastropovic artery epigastric artery radial artery and arterial conduits procured from other sites the next paragraph says procurement of the artery for grafting should not be reported as a separate service or co-surgery except when an upper extremity artery eg radial artery is procured now so it says don't use use so is harvesting the artery separately reportable well there's an add-on code for it so that pretty much says well yeah you can um do that three five six zero zero an add-on code harvest of upper extremity artery one segment for coronary artery bypass procedure so it says specifically in the code description that it's for a coronary artery bypass procedure now let's look at harvesting for veins so if it's a saphenous vein the guideline says no you don't code that separately that's part of the cabbage coat this is the most common site for a vein on the other hand harvesting of these veins can be reported separately using add-on codes upper extremity vein add-on code 35500 femoral popliteal vein 35572 so these are yes this happens is no there are also guidelines concerning co-surgery if one surgeon performs the bypass while another surgeon harvests the vessels the guidelines state the first surge of codes the bypass procedure the second one codes the same code with the modifier 80. remember the modifier 80 is for assistant surgeon so let's do some practice if you'd like to code this on your own let me read it then stop the recording and restart it when you're finished so a coronary bypass procedure uses three arterial grafts but no venous grafts the physician harvested internal mammary arteries for the procedure questions we'll go down each question it's a good idea to go through the questions because this kind of leads you to the correct code kind of step by step so graft done with arteries veins or both how many venous arterial grafts were used is harvesting the vessel separately reportable okay so we have three arterial grafts but no venous grafts on question one grass down with arteries veins or both arteries only how many three is harvesting reported separately no this is an internal memory so that's on that list of do not code separately so in this case you're going to report three three five three five coronary artery bypass using three arterial grafts three coronary artery wraps harvesting is not coated separately okay that's a fairly straightforward one let's try another again do this on your own if you wish stop the recording and start it up again a coronary bypass procedure uses one venous graft and one arterial graft the arterial artery graft was an epigastric artery the vein graft was a femoral popliteal segment so we're going to ask the questions arteries bands are both how many harvesting okay so let's look at the answers to the question arteries veins are both both how many one venus one artery is harvesting reported separately artery no venus um yes because the artery was epigastric and that's on that list of do not report separately the vein however is a femoral popliteal and that is reported separately so in this case we're going to do three codes we're going to three three five three three um one artery add-on code three three five one seven add-on code for um the main code is three three five three three the add-on code three three five one seven for the single venous and then harvesting for the vein only another add-on code three five five seven two so remember the add-on codes are always reported second so the artery harvesting the artery is not reported separately but harvesting the vein is okay so sometimes other procedures are performed with a cabbage and i'm going to talk about a couple of them one of these is an add-on code for an endoscopy used with the harvesting of a vein note that the coronary artery bypass is specifically mentioned in the wording for the code okay so there's the add-on code 33508 and it also says that this that um this where the code is listed this code is used only with three five one zero three three three five one zero three three five two three so it's saying it's only it's only used with these don't use it with other procedures so the another add-on procedure is a um coronary endo endo arthur endortherectomy this is an add-on code again which also specifically mentions that the sephora bypass so coronary and darterectomy open any method and it gives specific vessels and that is performed in conjunction with coronary artery bypass graft procedure each vessel so each time if it's multiple vessels using the doing this procedure you're going to report it several times finally cabbage procedures may also involve percutaneous insertion or removal of a ventricular assist device which is designed to help the blood flow from the ventricles the lower chambers of the heart so this is for percutaneous insertion there's also a code for removal and repositioning in the 33990-233997 so here's another practice a final practice so this time we're going to use all of the questions a coronary bypass procedure uses one arterial graft three venous grafts the physician harvested saphenous arteries for the procedure using an endoscopy with video assistance the physician also performed anatorectomy of the circumflex artery so here are the questions arteries veins are both how many of each is harvesting separately reported what other procedures so let's answer the questions arteries veins are both answer is both how many one vein that should be three veins three veins one artery is harvesting separately reportable no this is a saphenous um how other procedures are performed endoscopy and anatorectomy so you have three three five three three for a coronary artery graft uh three plus three venous grafts and then you have the endoscopy and the coronary artery enerectomy um endarterectomy so notice that you have the endoscopy code for the harvesting but you don't have a separate code for the saphenous vein because that's um not reported separately okay it is impossible to remember all the guidelines so i suggest you write these notes in your cpt book write in the four questions so again it takes you down step by step by step to find the right code under this section coding for venus grafting only make a note or highlight or whether that saphenous veins are included but the upper extremity and the femoral popliteal vein are not and then codes for arterial grafting in that section right in venus grafting also done and refer you to the add-on codes 33517-33523 and also note the codes that the arteries that are included and those that are not so that completes this video if you have questions or comments please feel free to contact me if you enjoyed this video please give it a like and subscribe by clicking on the picture in the lower right hand corner and again here are the books i have written on coding these are available on amazon you can click on the link or you can just go to amazon and type in my last name t-r-o-t-i-n [Music] thank you so much for listening i hope to have more lessons up soon thank you