CPT® Coding: Coronary Artery Bypass

The speaker, Terry Tropin, introduces himself as a healthcare administration informatics expert with certifications in RHIA and CCSP. He is also an AHIMA-approved ICD-10 trainer with over 20 years of teaching experience at Montgomery College. Tropin has authored books on coding, available on Amazon, and encourages viewers to like and subscribe for more content. The main topic is CPT coding for coronary artery bypass grafts (CABG), commonly known as CABGs. He explains the process of CABG, where veins or arteries are harvested from other parts of the body and grafted onto the heart to bypass blockages, such as those caused by atherosclerosis. The coding depends on the number of vessels used as grafts, not the number of coronary artery vessels. Tropin outlines the key questions needed to code for CABG: the types of grafts used (arteries, veins, or both), the number of grafts, whether vessel harvesting is separately reportable, and if other procedures were performed. He also mentions the guidelines for co-surgery in CABG procedures.

Tropin delves into the specifics of coding for CABG, focusing on the types of vessels used. He clarifies that for arterial grafts, the harvesting is part of the procedure and not coded separately, except for upper extremity arteries, which can be reported separately using an add-on code. For venous grafts, saphenous vein harvesting is part of the CABG and not separately reportable, while other veins like the upper extremity and femoral popliteal veins can be coded separately. Tropin also addresses an inconsistency in the guidelines regarding the reporting of artery harvesting, noting that while the introduction suggests not reporting it separately, an add-on code exists for doing so. He emphasizes the importance of understanding the guidelines for co-surgery, where one surgeon performs the bypass and another harvests the vessels, with the second surgeon using modifier 80 for their role.

Tropin presents practice scenarios to illustrate the coding process for CABG. In the first scenario, a procedure uses three arterial grafts without venous grafts, and the physician harvests internal mammary arteries. Tropin guides through the questions to determine the correct codes, noting that harvesting is not separately reportable for internal mammary arteries. The second scenario involves a procedure with one venous and one arterial graft, where the arterial graft is from the epigastric artery and the venous graft is from the femoral popliteal segment. Here, harvesting of the vein is reportable separately, and Tropin explains the coding process, including the use of add-on codes. He also mentions additional procedures that can be performed with CABG, such as endoscopy-assisted vein harvesting and endarterectomy, and provides the relevant add-on codes for these procedures.

In the final practice exercise, Tropin combines all learned elements for a comprehensive coding scenario. A coronary bypass procedure uses one arterial and three venous grafts, with saphenous arteries harvested using endoscopy and an endarterectomy of the circumflex artery performed. Tropin walks through the questions and provides the correct codes, including the endoscopy code for vein harvesting and the endarterectomy. He notes that the saphenous vein harvesting is not separately coded. Tropin emphasizes the importance of annotating CPT books with guidelines and questions to aid in coding. He concludes the video by inviting questions or comments, encouraging viewers to like and subscribe, and promoting his coding books available on Amazon.