Tips to Ensure a Successful CABG Coding

Here are some tips to ensure a pain-free CABG (coronary artery bypass graft) coding:

You should make it a point to examine the code choices. During CABG procedures, there are three CPT codes for anesthesia: 00562, 00566, and 00567.

The associated base units differ as per the procedure.

You should watch for pump documentation. The first question you need to answer when coding anesthesia during CABG is whether the anesthesiologist used a pump oxygenator during the procedure.

An 'off pump' case takes place when the surgeon operates on the patient's still-beating heart. The physician is required to document 'off pump' before you can report the codes with higher base unit values. It can be worth approximately $85 more for an average Medicare case; however see to it that your anesthesiologist has earned it before you code it.

And just as in any other type of procedure, the key to reimbursement is documentation.

You shouldn't always add qualifying circumstances

Some payers let coders report "qualifying circumstances" codes that explain aspects of the patient's situation that complicated the anesthesiologist's work. Three of these codes - 99100, 99116, and 99135 – might apply to cardiovascular cases.

You shouldn't include these codes with all CABG procedures. Often, Hypothermia is included in the anesthesia code and shouldn't be reported separately in those cases.

You should look for notes that add units

Documentation can sometimes justify extra base units; as such you should read your anesthesiologist's notes and the operative report carefully.

For instance, if the surgeon sews a graft during an off-pump procedure, the anesthesiologist is due one additional unit owing to the increased risk. Also, you can shift from 18 base units with 00567 to 20 base units with 00562 if the CABG procedure includes another heart procedure like valve placement or if the patient is having a re-do CABG more than one month after an original CABG surgery.

To get the full picture, you need to look at the operative note along with the anesthesia record to get the complete picture. If something is mentioned in the surgical note that counts as documentation, you can use in your anesthesia coding.