Coding For CABG-Open Heart Procedures

Coding for
CABG/Open Valve
and Miscellaneous
Heart Procedures
Joline Bruder, CPC, CPMA, CCVTC, CGSC
© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION
CONTROL PANEL
(a) - Grab Tab – click arrow to open/close Control Panel.

(a)
(b) - Mute – By default, attendees are muted (in listen-only mode) to minimize
(b)
background noises.
(c)
(d) (c) - View in full screen mode
(e)
(d) - Raise Hand – When vocal questions/comments are
allowed, please select the hand icon to get the
presenter’s attention. A red arrow means your hand is
raised.
(e) - Audio Pane – You can choose Computer Audio or Phone Call.
(f)
(g)
(f) - Questions pane – Attendees can ask Questions to organizers during a
session. Broadcast messages to attendees will also show here.
(g) - Handouts – Organizers can share handouts during webinars.

Handouts are made available in the Control Panel during the
session, which attendees can then download onto their own
devices.
© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 2

Coding CEU Certificates
CEU Certificates and Webcast Evaluations are only sent to those individuals
that register for BOCN webcasts. Please make sure that each individual
registers using their correct email address.
• AAPC –
• Coding CEU Certificates will be emailed out to all registered
attendees.
• Please give 5-7 business days
• BMSC –
• For Coding CEUs, please email Joline to request at:
jbruder@medaxiom.com
MedAxiom Disclaimer
This presentation is for general information purposes only and is not intended and does not constitute
legal, reimbursement, coding, business or other advice. Furthermore, it is not intended to increase or
maximize payment by any payer. Nothing in this presentation should be construed as a guarantee by
MedAxiom regarding levels of reimbursement, payment or charge, or that reimbursement or other
payment will be received. Similarly, nothing in this presentation should be viewed as instructions for
selecting any particular code. The ultimate responsibility for coding and obtaining
payment/reimbursement remains with the customer. This includes the responsibility for accuracy and
veracity of all coding and claims submitted to third party payers. Also note that the information
presented herein represents only one of many potential scenarios, based on the assumptions,
variables and data presented. In addition, the customer should note that laws, regulations, coverage
and coding policies are complex and updated frequently. Therefore, the customer should check with
their local carriers or intermediaries often and should consult with legal counsel or a financial, coding
or reimbursement specialist for any coding, reimbursement or billing questions or related issues. This
information is for reference purposes only. It is not provided or authorized for marketing use.

CPT® Disclaimer
CPT® copyright 2020 American Medical Association. All rights

reserved.
CPT® is a registered trademark of the American Medical

Association

Objectives
• Coronary Artery Bypass Grafts (CABG)

• Open Valve Procedures: Valve Anatomy Aortic, Mitral,
Tricuspid
• MAZE
• Other Heart Procedures including Heart and Great Vessels
and ECMO Procedures

Coronary Artery Bypass
CABG

The Heart

Picture of Bypass Grafts

Coronary Vessels
Arteries and their Branches
Left Anterior Descending

Left Circumflex (LC) Right Coronary (RC)
(LAD)
Diagonal Branches – Obtuse Marginals – SA = SA Node
D1, D2, D3 OM1, OM2, OM3 AV = AV Node
AM = Acute Marginal
Septal Perforators – PL = Posterior Lateral

PDA = Posterior Diagonal
S1, S2, S3
RVB Right Ventricular
Branch

Types of Grafts
VESSELS – Arteries/Veins
• Internal Thoracic artery (ITA, or LIMA)
o procurement is included in the coronary artery bypass procedure codes
• Radial Artery (from the arm)

o there is an add on code for procurement
• Great Saphenous Vein (from the leg)

o procurement is included in coronary artery bypass procedure codes
TYPES OF GRAFTS
• Arterial Grafts (LIMA, ITA, Radial)
• Venous Grafts (Saphenous vein, or upper extremity vein)

Venous Grafting for Coronary Bypass –Vein
Only
33510 – Coronary artery bypass, vein only; single coronary
venous graft
33511 – 2 coronary venous grafts
33516 – 6 or more coronary venous grafts

Arterial Only or Arterial/Venous Bypass Grafts
33533 Coronary artery bypass, single arterial graft

33534 - 2 coronary arterial grafts
33535 - 3 coronary arterial grafts
33536 - 4 or more coronary arterial grafts
*Use these codes in conjunction with 33533-33536
+ 33517 single vein graft (list in addition to code for
primary)
+33518 – 2 venous grafts
+33523 – 6 or more venous grafts © 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 13
Grafting Information
These are Add-On Codes and Modifier 51 Exempt
Procurement of the
saphenous vein graft is
included in the description of To report harvesting an To report harvesting an upper
the work for 33510-33516 and extremity vein (endoscopic), extremity vein (open), use
should not be reported as a use +33508 in addition to the +35500 in addition to the
separate service or co- bypass procedure bypass procedure (Billed only
surgery. once)
To report harvesting of a Procurement of the LIMA or To report harvesting an

femoropopliteal vein segment, RIMA is included in the arterial extremity artery (open)
report +35572 in addition to the graft codes 33533-33536 +35600
bypass procedure.

Saphenous Vein
• This is the most common used in bypass

grafts.
• The saphenous vein is located in the leg
• Procurement of a venous graft is integral
to the performance of a coronary artery
bypass using venous bypass. CPT code
37700-37735 – ligation of saphenous veins
are not to be separately reported in addition
to CPT codes 33510-33523 (coronary artery
bypass).

Add on code - Reoperation 33530
• Reoperation, coronary artery bypass or valve procedure, more

than 1 month after original operation (List separately in addition
to code for primary procedure)
• Use this code in conjunction with (33400-33496; 33510-33536,

33863)

Coronary Endarterectomy 33572
• Coronary endarterectomy, open, any method, of left anterior

descending, circumflex, or right coronary artery performed in
conjunction with coronary artery bypass graft procedure, each
vessel
• You list this code in addition to the primary procedure
• Can use this with codes 33510-33516, 33533-33536
• If endarterectomy is performed on the Aorta use unlisted code
33999

Other Billable Codes
Almost Always Performed in Conjunction with a CABG
33542 33545
Myocardial resection (e.g. Repair of postinfarction ventricular
ventricular aneurysmectomy) septal defect with or without
myocardial resection

SVR, SAVER, Dor Procedure
• 33548 Surgical ventricular restoration procedure, includes

prosthetic patch when performed

EPI-Aortic Ultrasound
• +76998 – Add on code

• Used for cannulation, cross-clamp evaluation, dissection.
Requires documentation of the findings of the aorta.
• CCI Specifically allows EPI-Aortic ultrasound to be billed
specifically with venous CABG. It cannot be used to procure the
graft

Anatomy of Heart Valves

Blood Flow Through The
Heart
• Oxygen poor blood enters the heart from the body
through the Superior Vena Cava and into the Right
Atrium
• The right atrium contracts and pushes the blood
through the Tricuspid valve and into the Right Ventricle
• The Right Ventricle contracts and pushes the blood
through the Pulmonary Valve and through the
pulmonary arteries the blood is sent to the lungs to
receive oxygen
• Next the oxygen rich blood returns to the heart via the
pulmonary veins and enters the Left Atrium. The left
atrium then contracts and pushes the blood through
the Mitral Valve into the Left Ventricle.
• Finally the left ventricle contracts and pushes the blood
through the Aortic Valve into the Aorta and out to the
body.

Heart Valves
Aortic Valve
Mitral Valve
Tricuspid Valve
Pulmonary Valve

Function of Aortic Valve
• Lies between the aorta and the left
ventricle
• Allows movement of oxygenated
blood from the left ventricle into the
aorta where it then flows to the rest
of the body
• Normal aortic valve has 3 cusps or
leaflets. Some have 2 which is a
congenital condition

Aortic Valve Stenosis
• Occurs when the hearts valve
narrows
• Prevents the valve from fully
opening
• Reduces/Blocks blood flow into the
aorta
• Causes the heart to work harder
and eventually limits the amount of
blood pumped

Function of Mitral Valve • Also known as the
bicuspid valve or left
atrioventricular valve
• The mitral valve lies
between the left atrium
and left ventricle
• It regulates the blood
flow from the lungs into
the left ventricle

Mitral Regurgitation or
Insufficiency
• Occurs when the valve doesn’t
close properly
• Blood then leaks backwards into
the atrium and the lungs
• Causes the heart to work harder to
pump the blood out to the body

Mitral Valve Stenosis • Narrowing of the valve
opening
• Mainly caused from
Rheumatic Fever
• Restricts blood flow to
the left ventricle
chamber

Function of Tricuspid
Valve
• Also known as right atrioventricular
valve
• It is positioned at the superior
portion of the right ventricle
• Prevents backflow of blood from
the right ventricle to the right atrium

Tricuspid Regurgitation or • Valve doesn’t close
Insufficiency properly
• This allows blood to

escape back into the
Right Atrium

Function of Pulmonary
Valve
• Lies between the right ventricle
and the pulmonary artery
• It has 3 cusps
• Allows blood flow from the right
ventricle into the pulmonary artery
to carry blood to the lungs

Pulmonary Valve Stenosis • Stenosis is when the
valve opening narrows
• Restricts the blood flow
into the pulmonary
artery from the right
ventricle
• Heart can enlarge due
to this condition
• Also increase
hypertension to the right
side of the heart
Pulmonary Valve • Valve doesn’t close
Regurgitation properly
• Allows blood backflow
from the pulmonary
artery to the right
ventricle
• A small amount of
backflow is normal; but if
increases it needs
medical attention

Open Aortic Valve Procedures

Valvuloplasty
• 33390 Valvuloplasty, aortic valve, open, with cardiopulmonary

bypass; simple (i.e., valvotomy, debridement, debulking and/or
simple commissural resuspension)
• 33391 Valvuloplasty, aortic valve, open, with cardiopulmonary
bypass; complex (e.g., leaflet extension, leaflet resection,
leaflet reconstruction or annuloplasty)

Aortic Valve Procedures
• Aortic Valve Procedures

- Conduction of apical-aortic conduit 33404
− Replacement, aortic valve – 33405-33410
− Replacement with aortic annulus enlargement, non-coronary sinus
33411-33413
− Repair, resection, -myectomy, aortoplasty 33414-33417

Aortic Valve Codes
• 33405 Replacement aortic valve open, with cardiopulmonary

bypass; with prosthetic valve other than homograft or Stentless
valve
bypass; with allograft (freehand)
bypass; with stentless tissue valve

Aortic Valve Code
33440 – Replacement aortic • Do not report with – 33405,
valve; by translocation of 33406, 33410, 33411,
autologous pulmonary valve 33412, 33413, 33414,
and transventriclular aortic 33416, 33417, 33475,
annulus enlargement of the left 33608, 33920
ventricular outflow tract with
valved conduit replacement of
the pulmonary valve (Ross-
Konno procedure)

Other Aortic Valve Procedures
• 33411 Replacement aortic valve; with aortic annulus enlargement – non coronary
sinus
• 33412 with transventricular aortic annulus enlargement (Konno Procedure)
• 33413 by translocation of autologous pulmonary valve with allograft replacement
of pulmonary valve (Ross Procedure)
• 33414 Repair of left ventricular outflow tract by patch enlargement
• 33415 Resection or incision of subvalvular tissue for discrete subvalvular aortic
stenosis
• 33416 Ventriculomyotomy (-myectomy) for idiopathic hypertrophic subaortic
stenosis
• 33417 Aortoplasty (gusset) for supravalvular stenosis

Bentall Procedure
33863 – Ascending aorta graft with CPB with aortic root
replacement using a valved conduit and coronary reconstruction.

Mitral Valve/Tricuspid Valve
Procedures

Mitral Valve
33420 - Valvotomy, mitral 33422 - Valvotomy, mitral valve,

valve, closed heart open heart, with
cardiopulmonary bypass (CPB)
33425 - Valvuloplasty, 33426 - Valvuloplasty, mitral

mitral valve with valve with prosthetic ring
cardiopulmonary bypass
33427 - Valvuloplasty, 33430 - Replacement, mitral

mitral valve radical valve
reconstruction with or
without ring
Tricuspid Valve
33460 – Valvectomy 33463 – Valvuloplasty

tricuspid valve with tricuspid without ring
CPB 33464 – with ring
33465 – Replacement 33468 - Repositioning
tricuspid valve and plication for
Ebstein anomaly

More on Valve Procedures
If multiple valves are 33530 - Reoperation, Use 33530 in conjunction

replaced or repaired code the coronary artery bypass or with 33400-33496; 33510-
extensive first followed by the valve procedure, more than 1 33536, 33863)
other codes and add 51 month after original operation
modifier (if your carrier (List separately in addition to
requires) to the other lesser code for primary procedure)
valued codes.

MAZE Procedures

MAZE
Procedure for Treatment of Atrial Fibrillation
The Maze Procedure is surgery performed to treat atrial fibrillation.
During the procedure, a number of incisions are made on the left A combination of surgical
and right atrium to form scar tissue, which does not conduct
electricity and disrupts the path of abnormal electrical impulses. incision and/or energy sources,
The scar tissue also prevents erratic electrical signals from
recurring. After the incisions are made, the atrium is sewn together such as heat, microwave, laser,
to allow it to hold blood and contract to push blood into the
ventricle. ultrasound or cryoprobe, is
Although the atrium is sewn back together, the erratic electrical used to create lesions that will
paths remain severed so that no unwanted electrical impulse can
cross the incision. The result is what looks like a children's maze in heal into scars that disrupt
which there is only one path that the electrical impulse can take
from the SA node to the AV node. The atrium can no longer conduction
fibrillate, and sinus rhythm (the normal rhythm of the heart) is
restored. Maze can be performed either through an open chest
procedure or a minimally invasive procedure. Ninety percent of
Maze surgeries are concomitant (done in conjunction) with other
open chest surgery, such as coronary artery bypass grafting, mitral
valve repair and/or valve replacement
MAZE Procedure
Operative tissue ablation and reconstruction of atria
33265 MAZE endoscopic, limited

33266 MAZE endoscopic, extensive
33254 MAZE open, limited
33255 MAZE open, off bypass
33256 MAZE open, on bypass
+33257 MAZE open, limited (done with
other heart procedure)
+33258 MAZE open, off bypass (done with
+33259 MAZE open, on bypass (done with

Left Atrial Appendage Ligation
4. Atrial Appendage Procedures
• Atrial appendage ligation, plication, or clip is included in mitral valve and MAZE
procedures and should not be reported separately when performed in the same session
as these procedures.
• If an atrial appendage procedure is performed with a cardiac procedure other than MAZE
or mitral valve, then it may be reported separately.
This is Taken from the Society
1) For removal of thrombus, use 33310/33315 (cardiotomy) and append modifier -59 (if it is of Thoracic Surgeons Q&A
bundled with the procedure performed) and -51.
2) For anything other than thrombus removal, append the -22 modifier to the main procedure or section of their website
use the unlisted code, 33999, to report the atrial appendage procedure.
3) If the atrial appendage procedure is the only procedure performed, report the unlisted code,
(33999).
• If the procedure is performed for the prevention of atrial fibrillation, it does not meet
medical necessity for Medicare and should not be reported.
• If it is done for the treatment of chronic atrial fibrillation, then medical necessity would be
met and should be reported considering the criteria outlined above.
Note that coverage of the procedure will be determined and will vary by payer.

Other Heart Procedures

Procedures of the Pericardial Sac
33016-33
33015 Tube Pericardiostomy
33020 Pericardiotomy for removal of clot or foreign body

(primary procedure)
33025 Creation of pericardial window or partial resection for
drainage (excludes Surgical thoracoscopy (VATS) 32659)
33030-33031 Pericardiectomy, with or without cardiopulmonary
bypass
33050 Resection of pericardial cyst or tumor

Procedures of the Pericardial Sac
❖ 33016 Pericardiocentesis including imaging guidance when performed
❖ 33017 – 33018 Pericardial draining with insertion of indwelling catheter
percutaneous, including fluoroscopy and/or ultrasound guidance when performed
33017 is for 6 and older without congenital anomaly and 33018 is for Birth through 5
Years or any age with congenital anomaly
❖ 33019 Pericardial drainage with insertion of indwelling catheter percutaneous
including CT Guidance
❖ 33020 Pericardiotomy for removal of clot or foreign body (primary procedure)
❖ 33025 Creation of pericardial window or partial resection for drainage (excludes
Surgical thoracoscopy (VATS) 32659)
❖ 33030 – 33031 Pericardiectomy subtotal or complete; without CPB and with CPB
❖ 33050 Resection of pericardial cyst or tumor
Neoplasms and TMR
33120 33130 33140 +33141

Excision of Resection of external Transmyocardial Transmyocardial
intracardiac tumor cardiac tumor Laser Revascularization
Revascularization performed at the time
(TMR) by of other open cardiac
thoracotomy; separate procedure(s) (List
procedure separately in addition
to code for primary
procedure 33400-
33496, 33510-33536,
33542)

Procedures for Heart & Great
Vessels
33300-33305 33310-33315 33320-33322 33330-33335
33300 Repair of 33310 Cardiotomy, 33220 Suture repair 33330 Insertion of

cardiac wound; exploratory (includes of aorta or great graft, aorta or great
without bypass removal of foreign vessels without vessels without
body, atrial or
33305 – with shunt or CPB shunt or CPB
ventricular thrombus
bypass w/out CPB 33222 – with 33335 – with
These procedures 33315 – with bypass bypass bypass
are for trauma These are not for These are not for
These are not for
wounds not congenital or congenital or
congenital or
surgically created diseases of the heart diseases of the heart
diseases of the heart
ones

Mechanical Circulatory Support
33967 Insertion of intra-aortic balloon assist device, percutaneous
33968 Removal of intra-aortic balloon assist device, percutaneous
33970 Insertion of intra-aortic balloon assist device through the

femoral artery, open approach
33971 Removal of intra-aortic balloon assist device including
repair of femoral artery with or without graft
33973 Insertion of intra-aortic balloon assist device though
ascending aorta
33974 Removal of intra-aortic balloon assist device from the
ascending aorta, including repair of the ascending aorta, with or
Extracorporeal Membrane Oxygenation (ECMO)or
Extracorporeal Life Support Services (ECLS)
Provides cardiac and/or respiratory support to the heart and lungs.
ECMO/ECLS continuously pumps blood out if the body to an

oxygenator where oxygen I added and carbon dioxide is removed, the
blood is warmed and then returned to the patient
2 Types - Veno-arterial and veno-venous.
Veno-arterial requires that two cannula are placed one in a large vein
and one in a large artery supports the heart and lungs
Veno-venous requires one or two cannulas that are placed in one or

two veins and supports the lungs only
More on ECMO/ECLS
Services directly related to Daily management of

cannulation, initiation, the patient are
management and
discontinuation are
reported by
different than services appropriate E/M
related to the patient codes
(33946-33949)
Insertion Codes
Percutaneous Open Sternotomy/Thoracotomy
33951 Insertion of 33953 Insertion of 33955 Insertion of

peripheral (arterial peripheral (arterial central cannula(e) by
and or venous and or venous sternotomy or
cannula(e) cannula(e) open (Birth thoracotomy (Birth – 5
percutaneous (Birth-5 – 5 Years) Years)
Years) 33954 (6 years or 33956 (6 years or
33952 (6 years or older) Older)
older)
Cannula Reposition Codes
33957 Reposition of 33959 Reposition of 33963 Reposition of

peripheral (arterial peripheral (arterial central cannula(e) by
and or venous) and or venous) sternotomy or
cannula(e) cannula(e) open (Birth thoracotomy (Birth –
percutaneous (Birth – – 5yrs), 5yrs),
5yrs), 33962 (6years or 33964 (6 years or
33958 (6 years or older) older)
older)
Decannulation (Removal)
33965 Removal of 33969 Removal of 33985 Removal of

peripheral (arterial peripheral (arterial central cannula(e)by
and/or venous) and/or venous) sternotomy or
cannula(e) cannula(e) open thoracotomy (Birth-
percutaneous(Birth - (Birth- 5yrs), 5yrs),
5yrs), 33984 (6 years or 33986 (6 years or
33966 (6 years or older) older)
older)
Other Cannula Procedures
+33987 33988 33989

Arterial Exposure with Insertion of left heart Removal of left heart
creation of graft vent by thoracic vent by thoracic
conduit (e.g. chimney incision incision
graft) to facilitate
arterial perfusion
(Use in conjunction
with 33953, 33954,
33955, 33956)
Initiation/Daily Management Codes
33946 - 33947 33948 - 33949

Initiation and setting of Daily Management of the
parameters of the ECMO/ECLS I ECMO/ECLS requires physician
performed by the physician 33946 oversite to include management
(Veno-Venous), 33947 (Veno- of blood flow, oxygenation, CO2
Arterial) clearance by the membrane lung
33948 (Veno-Venous), 33949
(Veno-Arterial)

Other Miscellaneous Procedures
Conduit to Aid in Cardiopulmonary Bypass (CPB)
+34714 +34833 +34716

Open femoral artery Open iliac artery exposure Open axillary/subclavian
exposure with creation of with creation of conduit or artery exposure with
conduit or delivery of delivery of endovascular creation of conduit or
endovascular prosthesis prosthesis or for delivery of endovascular
or for establishment of establishment of CPB by prosthesis or for
CPB by groin incision abdominal or establishment of CPB by
unilateral retroperitoneal incision infraclavicular or
unilateral supraclavicular incision
unilateral

Other Miscellaneous Procedures
35820 Chest exploration for post op hemorrhage, thrombosis

or infection.
21750 Closure of median sternotomy separation with or
without debridement
21627 Sternal debridement
93314/26 – TEE image acquisition, interpretation and report.

Some Final Surgery Guidelines
Subsequent to the Typical When a physician “Separate procedure”

decision for surgery performs more than should not be reported
postoperative care in addition to the code
(modifier 57), one is included in the one
for the total procedure
related E&M procedure/service on
surgical code (this is listed in CPT
encounter on the date the same date, same code book next to
immediately prior to session or during a procedure descriptions)
or on the date of port-operative period, However when a
procedure is included several CPT procedure is carried out
in the surgical code. modifiers may apply independently or
distinctly it may be
reported in addition to by
appending modifier 59
1 2 3 4

Case Examples

Case #1
Indications: 59 year old female with severe coronary artery disease including total occlusion of the right coronary
artery and preserved left trigger function
Findings: The patient had a first diagonal artery which was too diffusely diseased for bypass. The TEE revealed
no valvular heart disease.

Case #1 cont.
Description of operative procedure: Patient was taken to the operating room and
placed in a supine position; anesthesia was obtained. Patient was prepped and
draped in usual fashion.
A TEE was performed demonstrating no valvular heart disease. Greater saphenous
vein was harvested from lower extremity with invasive technique. Sternum was
divided and the left internal mammary artery was dissected and found to have good
flow. Patient was started on cardiopulmonary bypass. The right coronary artery was
bypassed with reverse saphenous vein graft in an end to side fashion. (33517) Next
the obtuse marginal artery was bypassed with reverse saphenous vein graft in an end
to side fashion. (33518) And finally the LIMA was used to bypass the LAD artery in an
end to side fashion. (33533) Cross lamp was then placed on the two proximal
anastomoses on the ascending aorta. Cross clamp was removed. Two pacing wires
were placed on the right ventricle, two on the right atrium, and two chest tubes were
placed. Patient was weaned from cardiopulmonary bypass and sternum was closed
with four sternal cables. 67
Case #1 Answer
33533 33518
One arterial (LIMA to Two venous bypass

LAD) bypass graft grafts were completed
was completed (saphenous vein to
right coronary and
saphenous vein to
obtuse marginal)

Case #2
Pre-operative Diagnosis: Severe aortic and mitral regurgitation
Post-operative Diagnosis: Severe aortic and mitral regurgitation
Procedure: Redo sternotomy, aortic valve replacement using a magna ease 25 mm bioprosthetic valve and mitral valve replacement using 29 mm
magna ease bioprosthetic valve and VA ECMO. And placement of intra-aortic balloon pump in the left femoral artery.
Patient was brought to the operating room after informed consent followed by the induction of general anesthesia and placement of arterial and
venous lines including Swan-Ganz catheter. Once this was completed we could not float the Swan-Ganz catheter during this time decision was
made to flow the catheter at the end of the surgery. A transesophageal echocardiogram was then put in place followed by evaluation of the
aortic and the mitral valve and the plan prior to incision was to replace the aortic valve 1st and then re-evaluate the mitral valve since
mitral valve regurgitation was about moderate to severe and the jet was more posterior directed jet which might be related to tethering
due to the dilated ventricle secondary to the severe aortic regurgitation. (no code for TEE) Patient was then positioned prepped and
draped in the standard surgical fashion followed by routine time-out and incision over the sternum over the previous incision. Once the
sternal wires were identified the sternal wires were then cut followed by opening of the sternum using an oscillating saw. The sternal
wires then removed followed by completion of the sternotomy followed by a dissection around the right to the left portions of the sternum
to free up the sternum for placement of the sternal retractor. (33530) The pericardium was then identified followed by dissection to isolate
the heart prior to which we also made right inguinal incision to isolate the right femoral artery and femoral vein. Cannulation sutures were
put in artery and the vein followed by continuation and completion of the sternotomy. Once the pericardium was identified the heart was
then dissected followed by identification of the aortic root and the ascending aorta followed by identification the right and the left
including SVC and IVC. Decision was made to get around the SVC and IVC followed by administration of total dose of heparin for goal
ACT of greater than 450 followed by cannulation of the femoral artery and femoral vein. The cannulation was performed using a Seldinger
technique. Once the goal ACT of greater than 450 was achieved patient was then cannulated in a bicaval configuration for venous
drainage. Antegrade cardioplegia vent needle was put in place followed by attempted retrograde cardioplegia cannula placement

Case #2 Cont.
Cross-clamp was applied followed by administration of cardioplegia via retrograde, but we noted that the cardioplegia needle was not in the
coronary sinus. The aortotomy was performed followed by direct visualization of the right left coronary ostia is and cardioplegia was administered
directly into the coronary ostia. Incomplete arrest of the heart further dissection was performed to visualize the aortic valve. The aortic
valve was then excised followed by placement of pledgeted valve sutures along the annulus and additional cardioplegia was given
during this time prior to the placement of the valve was sized to a 25 mm magna ease bioprosthetic valve patient's BSA at this time was
about 2.3. Once the valve was sewn into place the aortotomy was then reapproximated using 4 Prolene in a continuous running fashion.
(33405) Followed by administration of hotshot and removal of cross-clamp. Patient was then weaned down on cardiopulmonary bypass however
at this time the ejection fraction is approximately about 20% and the aortic and the mitral valve was evaluated. We consult Cardiology during this
time to read echocardiograms intraoperatively to assess the level of mitral regurgitation once patient was weaned of cardiopulmonary bypass with
some inotropic support we noted that the mitral valve regurgitation was more severe than preoperative echocardiogram. At this time the decision
was made to replace the mitral valve, although this time we realized that the patient if goes back on cardiopulmonary bypass to replace the mitral
valve would need some sort of mechanical support which includes intra-aortic balloon pump and or ECMO. After we made the decision with
Cardiology and based on the transesophageal echocardiogram cross-clamp was reapplied to the aorta followed by administration of antegrade
cardioplegia and cinching down the SVC and IVC cannulas. The sonographic groove was then dissected and opened followed by
visualization of the mitral valve which we noted was structurally intact with possibly some elongated anterior leaflet cords. Pledgeted
sutures placed along the annulus of the mitral valve followed by sizing the mitral valve to a 29 mm magna ease bioprosthetic valve
followed by suturing the valve in place. Once the valve was tied down the left atrium was closed using 4 Prolene in a continuous running
fashion in 2 layers. (33430) This was followed by administration of hotshot and removal of cross-clamp and placement of ventricular pacing
wires. Patient at this time will need full cardiopulmonary support with return of pacing patient was paced at 90 however ventricle function was
significantly reduced to approximately 10% at this time. A left femoral artery intra-aortic balloon pump was put in place during this time
followed by support of the balloon pump (33970) and evaluation of the valves on the echocardiogram the mitral valve appeared to be opening
well with a small area of paravalvular leak around the anterior portion. Decision was made to continue vein and support with cardiopulmonary
bypass to re-evaluate and see if the patient requires ECMO support during this time. Patient continues to need significant amount of
cardiopulmonary support therefore decision was made to resort to ECMO support with intra-aortic balloon pump

Case #2 Cont.
The femoral cannula was moved up to the SVC cannula was clamped and removed followed by snaring of the
cannulation stitch. After brief positive the cardiopulmonary support the circuit was switched to the ECMO circuit.
(33954) ECMO initiation was completed. (33947) 3 chest tubes were put in place followed by closure of the sternum using
sternal wires once hemostasis was achieved all cannulation sites and anastomotic sites were recheck for bleeding some oozing
was present however it was not significant surgical bleeding at this time. Protamine was given for to partially reverse the ACT to
about 200 range. Once the chest was reapproximated using sternal wires subcutaneous tissues and skin was closed using
Vicryl and Monocryl for skin femoral groin cannulation site was also partially closed using Monocryl and Vicryl. And intra-aortic
balloon pump was secured in place. During this time patient was hemodynamically stable the ventricle appear to be ejecting
partially on the transesophageal echocardiogram. LV vent was attempted prior to closure of the chest however be has
significant resistance at the stylet against newly placed mitral valve therefore decision was made to continue to pursue
ventricular ejection rather than place a vent at this time. Patient was then transported cardiac ICU in a critical but
hemodynamically rather stable condition.

Case # 2 Answers
• 33430 Mitral Valve

Replacement
• 33405 Aortic Valve
Replacement
• 33530 Re-do Valve
• 33954 ECMO
• 33970 Balloon Pump
• 33947 Initiation of ECMO
Case #3
PREOPERATIVE DIAGNOSES:
1. Critical left anterior descending and left main stenosis.
2. Coronary artery disease.
3. Status post non-ST elevation myocardial infarction.
4. Unstable angina.
5. Shortness of breath.
6. Dyspnea on exertion.
7. Congestive heart failure, acute on chronic systolic and diastolic, New York Heart Association Class 3.
8. Cardiomyopathy.
9. Chronic kidney disease stage 4, GFR of 19, creatinine of 2.84 with a previous history of dialysis post procedure.
10. Chronic obstructive pulmonary disease.
POSTOPERATIVE DIAGNOSIS:
1. Critical left anterior descending and left main stenosis.
2. Coronary artery disease.
3. Status post non-ST elevation myocardial infarction.
4. Unstable angina.
5. Shortness of breath.
6. Dyspnea on exertion.
7. Congestive heart failure, acute on chronic systolic and diastolic, New York Heart Association Class 3.
8. Cardiomyopathy.
9. Chronic kidney disease stage 4, GFR of 19, creatinine of 2.84 with a previous history of dialysis post procedure.
10. Chronic obstructive pulmonary disease.
11. Arthritis.
12. Left atrial enlargement.
13. History of percutaneous coronary intervention.
14. In-stent restenosis, last stent was in October of 2019.
15. Obstructive sleep apnea.
16. Obesity with body mass index of 37.

Case #3 Cont.
OPERATION:
1. Transesophageal echocardiogram.
2. Endoscopic vein harvest, left lower extremity.
3. Left atrial reduction plasty for left atrial enlargement with left atrial appendage excision.
4. Anterior mediastinal lymph node dissection.
5. Urgent off pump coronary bypass grafting x5 vessels.
a. In situ left internal mammary artery to left anterior descending artery.
b. Saphenous vein graft from the aorta to first diagonal artery.
c. Saphenous vein graft from the aorta sequenced to the 1st obtuse artery and the 2nd obtuse marginal artery.
Saphenous vein graft from the aorta to the posterior descending artery
BRIEF HISTORY: The patient is a 60-year-old female who presented with complaints of chest pain. She was
worked up by and underwent cardiac catheterization. She initially presented with a non-ST- elevation MI.
The cardiac catheterization revealed a critical left main stenosis and LAD stenosis and surgical team was then
consulted for evaluation for emergent coronary artery bypass grafting. I saw and examined the patient,
discussed with her disease process, risks, benefits, alternatives, and answered all questions, explaining to her
the procedure.
She voiced understanding and wanted to have this done as soon as possible. Preop workup was completed. The patient did have
chronic kidney disease stage 5 at one point where she was on dialysis after surgery

Case #3 Cont.
DESCRIPTION OF PROCEDURE: The patient was brought to operating room. Once preop workup was completed, consents were obtained.
General endotracheal anesthesia was initiated. Patient was administered IV
antibiotics. Preoperative antibiotics to include Ancef and vancomycin secondary to the fact that the patient was obese and had been in the
hospital preoperatively for an extended period of time. Once the patient was brought in the operating room, general endotracheal
anesthesia was initiated. The patient's neck was prepped and draped in a standard
sterile fashion. A time-out was conducted and a Cordis catheter and Swan- Ganz catheter placed in standard sterile technique by the Anesthesia
team.
Once the lines and tubes were in place, the patient also had a radial arterial line and a Foley catheter placed in standard sterile technique.
Once all lines and tubes were in place, the patient was positioned in supine position. All skin pressure points were protected. The patient's
neck, chest, abdomen, pelvis, and bilateral lower extremities were all prepped and draped in a standard sterile fashion. A time-out was
conducted and procedure was initiated.
At this point, a TEE probe was placed by the anesthesia team and I did the supervision and interpretation of the imaging. Once the
echocardiogram probe was placed by the Anesthesia team, echocardiogram was done. Patient was found to have left atrial
enlargement as expected and cardiomyopathy, but there was no valvular issues noted that were significant enough for
any intervention. (93314/26) Aorta was also noted to be without any atheromatous disease. There was no clot noted in the left atrial
appendage either. Once the echocardiogram was completed, a time-out was conducted and procedure was initiated.
At this point, the PA made an incision at the medial aspect of the left lower extremity at the knee and carried down with Bovie electrocautery. Greater saphenous
vein was identified. Systemic heparinization using 5000 units of heparin were administered in order to prevent any clotting or thrombus formation within
the vein during the harvest. Next, endoscopic vein harvest device was then used to harvest the vein in its entirety from the saphenofemoral junction down
to the lower calf. (33508) Once the vein was harvested, it was passed off to the back table. Vein tunnel was then checked and confirmed and noted to be hemostatic
without any bleeding or other issues.

Case #3 Cont.
I made an incision in the midline for a sternotomy simultaneously to the PA and carried down with Bovie electrocautery all the way down to the
sternum. Sternum was then divided exactly down the center using a sternal saw. Once the sternum was opened, periosteum of sternum was then
cauterized using Bovie electrocautery. Hemostasis was completely achieved and noted. At this point, attention was then turned to the left
pleural space. However, as soon as the chest was opened, there was noted to be dense and extensive lymphadenopathy noted in the
anterior mediastinum. Several of these nodes were harvested due to the fact that they did seem suspicious and passed off as
specimen(38530 not 38746) and following this, attention was then turned to the left pleural space. The left pleural space was opened
and lung was pushed out of the way. Mammary retractor was then placed and left internal mammary artery was identified. Left internal
mammary artery was then harvested in the standard fashion using Bovie electrocautery and clips distally down to the bifurcation, proximally
all the way to the subclavian vein. Once the mammary artery was completely harvested off the chest wall, systemic heparinization using an
additional 5000 units of heparin were administered in order to prevent any clotting or thrombus formation within the mammary. After the
harvest, the mammary artery was then ligated distally, divided, and prepared. Topical fascia was removed from the mammary artery and topical
papaverine was injected in the mammary artery to allow it to dilate out. Mammary artery was noted to have a good pulse and flow within it
and was of good quality and caliber for use. Once the mammary artery was harvested, it was preserved and pushed out of the way. At
this point, the mammary retractor was removed and a standard sternal retractor was placed. The sternum was then opened and attention was
then turned to the pericardial sac. This was opened in standard inverted T- fashion. Heart was noted to be in normal resting position with
normal anatomy. Left upper aspect of the pericardial sac was also divided all the way down to the phrenic nerve. The phrenic nerve was then
identified and preserved. This was to allow the mammary artery to lay on the medial aspect of the left upper lobe of the lung out of the way of
the sternotomy incision. Once the pericardial sac had been opened, plan was to do this with an off pump technique. Therefore, the Chase
stabilizer was used and systemic heparinization was then done by the Anesthesia team in order to maintain ACT above 350 throughout the
operation by intermittently checking ACTs, administering heparin, and comparing baseline ACT. Once the ACT was adequate, bypass
grafting was initiated. A deep stitch was placed behind the heart for retraction. Attention was first turned to the left atrial appendage.
Due to the fact the patient did have left atrial enlargement, it was decided to proceed with a left atrial reduction plasty and the left
atrial appendage was then excised and passed off as specimen. (33999???) Staple line was checked and confirmed and noted to be
hemostatic without any bleeding or other issues.

Case #3 Cont.
At this point, the distal targets were then identified in the LAD, the diagonal artery, the 1st obtuse marginal artery, 2nd obtuse
marginal artery, and the posterior descending artery. All targets were of good quality and caliber for bypass grafting; however,
there was not enough vein available. It was decided to do the 1st obtuse marginal artery and the 2nd obtuse marginal artery as a
sequence graft. Bypass grafting was then initiated. First anastomosis to be created was the vein graft to the first diagonal artery
using a 7-0 Prolene suture and a 1.5 mm shunt in standard circular fashion in an end-to-side fashion. Anastomosis was perfect and
noted to be intact. (33517) The vein grafts were appropriately sized, cut, and prepared and attention was then turned to the obtuse
marginal targets. Both were identified, dissected out, and bypass grafting was initiated. The first anastomosis to be created was the
vein graft to the 2nd obtuse marginal artery using a 7-0 Prolene suture and a 1.75 mm shunt in standard circular fashion in an end-
to-side fashion. (33518) Anastomosis was noted to be perfect without any problems or any leaks or any other issues. Attention was
then turned for the 1st obtuse marginal artery. Vein graft lay perfectly without any undue tension or kinking. First obtuse marginal
artery anastomosis was then created using a 1.75 mm shunt and a 7-0 Prolene suture and the vein graft which had been
anastomosed to the 2nd obtuse artery already. (33519) This was done as a side-to- side anastomosis for the 1st obtuse marginal
artery and an end-to-side anastomosis for the 2nd obtuse marginal artery. Once this anastomosis was completed, vein grafts were
appropriately sized, cut, and prepared for the proximal anastomosis and attention was then turned to the LAD. Mammary artery
was then anastomosed directly to the LAD using a 7-0 Prolene suture and a 1.75 mm shunt in a standard circular fashion in an end-
to-side fashion. (33533) Once the anastomosis was completed, it was cinched down and tied down. Excellent hemostasis was
achieved and noted. Mammary artery lay perfectly without any undue tension or kinking. Pedicle mammary artery was then tacked
to the epicardium using 6-0 Prolene suture in order to prevent any undue tension or kinking in the mammary artery. Mammary
artery lay perfectly without any problems. At this point, attention was then turned to the fifth and final anastomosis. The vein graft
was then anastomosed directly to the posterior descending artery using a 7-0 Prolene suture and a 1.75 mm shunt in a standard
circular running fashion in an end-to-side fashion. (33521) Once the anastomosis was completed, it was cinched down and tied
down. Excellent hemostasis was achieved and noted. Attention was then turned to the proximal anastomoses. Vein grafts were
appropriately sized, cut, and prepared for the proximal anastomoses.

Case #3 Cont.
Ascending aorta was palpated and noted to be without any atheromatous disease. Systolic blood pressure was brought down below 85 mmHg.
A partial occluding Satinsky J clamp was then applied to the ascending aorta. Aortotomy was then created and enlarged using a 4 mm punch,
and anastomoses were then created of the vein graft. Proximal anastomosis superior most was the marginal artery vein graft.
This was anastomosed using a 6-0 Prolene suture in the standard circular running fashion in an end-to-side fashion. Next inferior was the
diagonal artery anastomosis also in a standard circular running fashion using a 6-0 Prolene suture and finally the one to the posterior descending
artery was anastomosed to the right side inferior most. This anastomosis was created using a 6-0 Prolene suture in a standard circular running
fashion as well. Once all 3 proximal anastomoses were completed, the clamp was released, de-airing maneuvers were done. Anastomoses were
then cinched down and tied down. Excellent hemostasis was achieved and noted. All distal and proximal anastomoses were checked and
confirmed and noted to be hemostatic without any bleeding or other issues. At this point, protamine was then
administered to fully reverse the heparin. ACT went back down to baseline. Proximal graft markers were placed. Hemostasis was completely
achieved and noted. Chest tube was then placed, 1 in the left pleural space and 1 in the mediastinum. Both were tacked to the skin using
2-0 silk sutures and connected to Pleur-evac suction. Once the hemostasis was completely achieved, ACT was at baseline and we
decided to complete the operation. Chest tubes were then placed and pericardial sac was then loosely reapproximated using 2-0 silk sutures
in order to prevent any undue tension or kinking in the mammary artery or any other graft and furthermore to prevent any adhesion or scar
tissue formation. Once the pericardial sac was closed, hemostasis was completely achieved. The
sternum was then reapproximated using sternal wires, 4 in the manubrium, 5 in the sternum. Wires were pushed and turned over. Sternum was
noted to be completely aligned without any step-offs, clicks, or misalignments.
Wound was then irrigated with antibiotic irrigation. Sternal fascia was closed using #1 Vicryl in a running fashion. Deep dermal layer was
closed using 3-0 Monocryl in a running fashion. Skin was closed using 4-0 Monocryl in a running fashion. Dermabond applied, sterile dressing
applied. Chest tubes were then connected to Pleur-evac suction. Patient subsequently transferred to the ICU in excellent stable condition.
Patient tolerated the procedure well without any complications. All lap and instrument counts were correct at the end of the operation.

Case #3 Answers
❖ 33533 – 1 Artery Bypass
Picture For Reference Only
❖ 33521 – 4 Venous Bypasses (Doesn’t represent procedure
❖ 33999? – Left Atrial done)
Appendage
❖ 38530 – Mammary Lymph
Node
❖ 33508 – Endoscopic Vein(s)
Harvest
❖ 93314/26 - TEE Interp

Case #4
Positioning and Preparation
The patient is taken to the operating room and placed in the supine position. Central venous monitoring and continuous arterial monitoring are
established. General tracheal anesthesia is accomplished. A surgical time-out confirms the correct patient's identity and procedure to be
performed. The patient's angiograms are reviewed in the operating room at a dedicated workstation. TEE is established and images are
reviewed confirming the current status of ventricular function. (no code)
The patient is prepared from chin to toes with chlorhexidine detergent and Chloroprep solution including circumferential preparation of the legs.
Conduit Harvesting
A small vertical incision above the left knee is used to identify the greater saphenous vein, which is harvested to the level of the groin
with endoscopic technique. (33508) The left internal mammary is harvested as a skeletonized graft maintaining an extrapleural plane of
dissection. The incisions are closed in layers with absorbable suture. The saphenous vein branches are ligated. A median sternotomy is performed
Cardiopulmonary bypass
The patient is anticoagulated with heparin. The ascending aorta and right atrium are cannulated for cardiopulmonary bypass. A vent/cardioplegia
catheter is placed into the ascending aorta. A retrograde cardioplegia catheter is placed into the coronary sinus via the right atrium. The activated
clotting time exceeds 500 seconds. Cardiopulmonary bypass is established after retrograde autologous priming of the arterial and venous limbs of
the cardiopulmonary bypass circuit.
The ascending aorta is occluded. Cardioplegia is administered in an antegrade manner to cause cardiac arrest, then changed to 10 degrees
Celsius. All successive cardioplegia is given in a retrograde manner at 10 minute intervals and is accompanied by administration of cardioplegia
via the constructed vein bypass grafts. The left ventricular vent is placed via the right superior pulmonary vein.
Distal Anastomoses
Graft 1: PL1. Size 2.0 mm. Condition: fair. Conduit: saphenous vein. Conduit condition: excellent. (33517)
Graft 2: PDA. Size 2.0 mm. Condition: fair. Conduit: saphenous vein. Conduit condition: excellent. (33518)
Graft 3: LAD. Condition: fair. Size 2.0 mm. Conduit: LIMA, Conduit condition excellent. (33533)

Case #4 Cont.
The posterior wall lateral to the PDA is severely thinned and has evidence for transmural infarction. This segment is aneurysmal. The initial plication
is not secure. The aneurysm is opened. A pericardial patch is placed inside the ventricle and secured with mattressed suture to another
patch on the epicardial surface. The ventriculotomy is secured with suture incorporating the patch. This aneurysm closure is secure with
no further signs of ventricular bleeding or myocardial tearing. (33542)
Proximal Anastomoses
Cardioplegia infuses in a retrograde manner at 37 degrees. The proximal vein anastomosis is formed to the ascending aorta under a continued,
single episode of aortic crossclamp while cardioplegia continues to infuse in a retrograde manner at 37 degrees Celsius. Air is excluded from the
ascending aorta. Cardioplegia is changed to warm plain blood after rewarming of the ventricles is assured. Cardioplegia is changed to antegrade
administration. Air is excluded from the cardiac chambers. The aortic crossclamp is released.
Separation from Cardiopulmonary Bypass
Excellent hemostasis is assured at all anastomoses. Excellent flow in all grafts is confirmed by doppler interrogation. Epicardial pacemaker wires are
placed on the right atrium and right ventricle. Cardiopulmonary bypass is weaned and discontinued. TEE evaluation demonstrates regional wall
motion abnormalities. The inferior wall remains akinetic as it was preoperatively. All other wall have improved function. Ventricular function is
improved from preoperative baseline. A test dose of protamine sulfate is well tolerated.
The cardiopulmonary bypass cannulae are removed. The remaining protamine sulfate is administered to completely reverse heparin.
Volume from the CPB circuit is transfused to maximally conserve PRBC mass. The residual blood in the CPB circuit is concentrated with the cell
saver and reinfused. Excellent hemostasis is assured throughout. Heparin concentration is zero. The pericardium is copiously irrigated with saline. A
chest tube is placed through the anterior mediastinum into the posterior pericardium. The pericardium is closed with interrupted sutures from
diaphragm to innominate vein. A chest tube is placed into the left pleural space. The sternal tables are approximated with interrupted stainless steel
wires. The remaining soft tissues are closed with absorbable suture. Dry dressings are applied. The patient is taken to the CICU in stable condition
having tolerated the procedure well.

Case #4 Answers
❖ 33533 - One Arterial Bypass

❖ 33518 – Two Venous
Bypasses
❖ 33542 – Myocardial
Resection (e.g. ventricular
aneurysmectomy)
❖ 33508 – Endoscopic Vein
Harvest
(Pictures for reference only)

83
Q&A Joline Bruder, CPC, CPMA,
CCVTC, CGSC
jbruder@medaxiom.com

Coding For CABG-Open Heart Procedures

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Coding For CABG-Open Heart Procedures

Uploaded by

Copyright:

Available Formats

Coding for

(a) - Grab Tab – click arrow to open/close Control Panel.

(d) (c) - View in full screen mode

(g) - Handouts – Organizers can share handouts during webinars.

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 2

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 4

CPT® copyright 2020 American Medical Association. All rights

CPT® is a registered trademark of the American Medical

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 5

• Coronary Artery Bypass Grafts (CABG)

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 6

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 7

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 8

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 9

Left Anterior Descending

Septal Perforators – PL = Posterior Lateral

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 10

• Radial Artery (from the arm)

• Great Saphenous Vein (from the leg)

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 11

33511 – 2 coronary venous grafts

33512 – 3 coronary venous grafts

33513 – 4 coronary venous grafts

33514 – 5 coronary venous grafts

33516 – 6 or more coronary venous grafts

33533 Coronary artery bypass, single arterial graft

To report harvesting of a Procurement of the LIMA or To report harvesting an

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 14

• This is the most common used in bypass

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 15

• Reoperation, coronary artery bypass or valve procedure, more

• Use this code in conjunction with (33400-33496; 33510-33536,

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 16

• Coronary endarterectomy, open, any method, of left anterior

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 17

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 18

• 33548 Surgical ventricular restoration procedure, includes

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 19

• +76998 – Add on code

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 20

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 21

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 22

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 23

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 24

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 25

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 26

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 27

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 28

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 29

• This allows blood to

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 30

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 31

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 33

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 34

• 33390 Valvuloplasty, aortic valve, open, with cardiopulmonary

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 35

• Aortic Valve Procedures

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 36

• 33405 Replacement aortic valve open, with cardiopulmonary

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 37

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 38

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 39

© 2020 MedAxiom DO NOT DISTRIBUTE WITHOUT PERMISSION 40