On Demand: Coding for Open Heart Procedures - Valves, CABG, and Miscellaneous Heart Procedures-Question and Answers

Question and Answers

Pdf Summary

In this Q&A session, various coding topics related to open heart procedures are discussed. Here is a summary of the key points:<br /><br />Q1: For the medical necessity of code 33268, documentation of atrial fibrillation is required, and the LAA clip is performed to prevent possible thrombus.<br /><br />Q2: When coding for mitral valve problems in ICD-10, if the documentation does not specify non-rheumatic, the default is to use the Rheumatic Valve Codes I08. It is important to ensure specific documentation for patients with multiple valve diseases.<br /><br />Q3: The code 33300 with ICD-10 code I97.52 (accidental puncture or laceration of circulatory system organ or structure during another procedure) may be used in rare cases where the puncture/laceration is caused by another provider and the CT surgeon is called in to correct it. However, this code is typically used for trauma, and the Coding Companion guidelines should be considered as guidance.<br /><br />Q4: If a PA or NP is allowed by state scope of license, they can remove an intra-aorta balloon assist device after surgery and bill for it using modifier 79, as these devices are not considered part of heart procedures.<br /><br />Q5 & Q6: The management of ECMO post-surgery can be done by a PA-C or CRNP if allowed by the hospital and state scope of license. However, the supervision requirements apply to the office, not the facility. The initiation of ECMO is typically performed by the surgeon at the time of insertion.<br /><br />Q7: If an arterial line is placed by the surgeon due to insufficiency of the one placed by anesthesia, code 36620 should not be billed as arterial lines are included in the Global Surgery package.<br /><br />These coding guidelines and recommendations should be followed based on the specific circumstances and documentation provided.

Keywords

coding topics

open heart procedures

atrial fibrillation

LAA clip

mitral valve problems

ICD-10 codes

accidental puncture

CT surgeon