N17.9; I12.9; N18.9. The patient was placed on cardiopulmonary bypass for this procedure. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The Heart Bypass Vessel. However one could argue that 93539 is only for bypass grafts. I found the following from CPT Assistant, but it is a bit old and may be outdated: Well, let’s just take a look at the first bypass guideline: B3.6a: Bypass procedures are coded by identifying the body part bypassed “from” and the body part bypassed “to.” The fourth character body part specifies the body part bypassed from, and the qualifier specifies the body part bypassed to. 02100Z9 B. The body parts listed as qualifiers for coronary bypass, on the other hand, can be found in one of three body systems: Heart and Great Vessels, Upper Arteries, and Lower Arteries. As we prepare and progress in our understanding of the future ICD-10 coding system, we continue to uncover the differences from the ICD-9 system. For this reason, pedicled grafts are coded using the second row of the 021 table, which only has one device option, No Device. The other artery was bypassed using a pedicle LIMA graft. Example: Two-vessel CABG using autologous saphenous vein graft from the aorta to the distal right coronary artery and acute marginal branch and one-vessel pedicled left internal mammary artery (LIMA) bypass to the circumflex using an open approach. Left Internal Mammary Artery. Postural orthostatic tachycardia syndrome, All About Cardiovascular System and Disorders, Internal mammary artery angiography should be a routine component of diagnostic coronary angiography. The arterial mission is simple: deliver oxygen-rich blood to the body’s organ and tissues. Let’s take a noncoronary example. The proximal portion of the LAD is seen to be occluded. Bypasses from the femoral artery to the popliteal artery (fem-pop) are relatively common. for Accurate CPT and ICD-10-PCS Code Assignment. Kristi has an extensive background in coding education and consulting and is a national speaker on topics related to ICD-9, ICD-10, and CPT coding, as well as code-based reimbursement. But if we focus on the procedure first and then come back to the guideline later, I promise it will make more sense. At the cellular level, oxygen is released to the tissues and carbon dioxide is absorbed and routed to the veins, which empty into the main vein, the vena cava, which returns blood to the right side of the heart. Objectives ... (LIMA) to the left anterior descending (LAD) ... (D1), utilizing Y graft. There are specialized catheters available for direct cannulation of the left internal mammary artery. She develops web-based and instructor-led training material and conducts training in ICD-10-CM/PCS. Valid for Submission. ICD-10-PCS Code(s): 02100Z9 Rationale: The abbreviation LIMA stands for left internal mammary artery, and LAD stands for left anterior descending. That second sentence is a mental tongue twister! Google will show only non-personalized ads to our users in the EEA as per the settings chosen by us. We talk about bypasses in traffic or figurative bypasses at work when we develop “workarounds” to circumvent a problem. There are two main approaches. Blood is routed back to the left side of the heart and the process is repeated. And I also think ICD-10-CM is pretty logical; the answers…, Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer. The sternal wires indicate the post sternotomy status. Starting with Bypass, the index main term is Bypass; subterm artery and further subdivided by coronary. One of the things that delights me about ICD-10-CM is that I find new codes (codes new to me, that is) almost daily. aorta with autologous venous tissue, open approach * 02100Z9-Coronary artery bypass, one site from LIMA, open approach * 06BP4ZZ-Excision of right greater saphenous vein, percutaneous endoscopic approach * 5A1221Z-Cardiopulmonary bypass 23 CABG Example MPU 2016 Official coding guidance continues to confound by switching it up for coronary artery bypass graft (CABG) procedures with the next guideline: At first glance, it seems confusing, but again, it’s all about blood flow. Example: Two-vessel CABG using autologous saphenous vein graft from the aorta to the distal right coronary artery and acute marginal branch and one-vessel pedicled left internal mammary artery (LIMA) bypass to the circumflex using an open approach. The final bypass guideline addresses code assignment when multiple coronary arteries are bypassed and have different devices and/or qualifiers: The type of graft, free versus pedicled, determines the sixth character for the device. Compression of the left brachial artery during the injection will reduce the flow to the left upper limb and enhance flow into the LIMA. Want to receive articles like this one in your inbox? To keep all CABG procedures in the same 021 table, the body part becomes the coronary artery – the body part bypassed “to” and the qualifier the body part bypassed “from.”. The classic first step in coding is to read the guidelines, but in the case of many ICD-10-PCS guidelines, starting there may prove to be confusing and frustrating. The ICD-10-PCS code assignment for this case example is: 02120Z9, Bypass, artery, coronary, Three sites The most common type of free graft comes from the saphenous vein from the patient’s leg. One of the highlights of my year, and most definitely in…, The dilemma of coding COVID-19 is revealed. Mid-Atlantic Surgical Associates is the largest volume cardiac surgery group in the New York - New Jersey tri-state area. The patient was admitted, and an off-pump CABG was performed by loosening the left internal mammary to bypass LAD. A LIMA bypass is considered a pedicled graft. Bypassing the bypass guidelines for the coronary and peripheral arteries. In both cases, the body part being bypassed “to” is the coronary artery or arteries, but the body part bypassed “from” varies, depending on the where the graft is connected on the other end. Rationale: Two of the arteries were bypassed using a saphenous vein graft from the aorta. It opens the heart’s blood flow, saving the life of the patient. The center of the circulatory system is the heart. • Coronary artery bypass procedures are coded differently than other bypass … Instructional notes under code 36.1- Bypass anastomosis for heart revascularization: Code also cardiopulmonary bypass [extracorporeal circulation] (heart-lung machined) 39.61 Tip: The determining factor for coding an aortocoronary artery bypass graft operation is the number of coronary arteries involved rather than the number of grafts. A normal coronary artery transports blood to the heart muscle itself, not through the main circulatory system. The Official Coding and Reporting Guidelines for ICD-10-CM state that other clinicians may document body mass index (BMI), but the provider…, The new code is expected to be here in October. The first lucky organ to receive fresh blood supply is the heart muscle itself. A. Coronary artery bypass graft (CABG) procedures are not the only ones coders will report using the root operation Bypass in ICD-10-PCS. A portion of the left greater saphenous vein was harvested using an open approach. Rationale: Both ICD-9-CM and ICD-10-PCS require a distinct code for the LIMA bypass. Coronary and peripheral arterial bypass procedures can be tricky and the guidelines can be baffling, but if you focus on the anatomy and always remember blood flow, you can master the bypass guidelines. 03L10ZZ is a valid billable ICD-10 procedure code for Occlusion of Left Internal Mammary Artery, Open Approach . In a study of 130 cases, they used 5F LIMA catheter which was initially directed to left subclavian artery and then advanced over a guidewire for superselective LIMA cannulation [1]. LAD is identified by the septal branches arising from it. LIMA stands for left internal mammary artery and is an artery that runs from the left collarbone area down the chest wall. The image has been darkened a bit by post processing to visualize the LIMA and LAD (left anterior descending coronary artery) well. Using this approach, theoretically, all sides of the heart can be approached. Kristi has more than 20 years of industry experience.  | ICD10monitor.com, a division of MedLearn Media, Inc. Case 1.429 (ICD-10-PCS Coding) Open LIMA bypass to the LAD ICD-10-PCS Code(s): _____ © 2017 American Health Information Management Association Case 1.429 Answer and Rationale 02100Z9 Rationale: The abbreviation LIMA stands for left internal mammary artery, and … Because then we look at the ICD-10-PCS coding guidelines, which are a confusing mess. Off-pump coronary artery bypass or "beating heart" surgery is a form of coronary artery bypass graft (CABG) surgery performed without cardiopulmonary bypass (heart-lung machine) as a treatment for coronary heart disease.It was primarily developed in the early 1990s by Dr. Amano Atsushi. Answer: 02100Z9 Bypass Coronary Artery, One Artery from Left Internal Mammary, Open Approach 021209W Bypass Coronary Artery, Three Arteries from Aorta with Autologous Venous Tissue, Open Approach Putting you on the heart-lung bypass machine. That ends the simplicity of the root operation Bypass. It has stood the test of time as the best graft for a coronary artery, being a live arterial graft with very little likelihood for atherosclerotic lesions. In an aortocoronary bypass, coronary occlusions are treated with two main types of bypass: aortocoronary and internal mammary. Greater saphenous vein graft is done to the obtuse marginal artery. Blood leaves the left side of the heart through the main artery, the aorta, which connects to other arteries. Page 3 in addition to code for primary procedure) • 33508 – Endoscopy, surgical, including video-assisted harvest of vein(s) for coronary artery bypass proce- dure (List separately in addition to code for primary procedure) Venous Graft Only If only venous grafts are being utilized for the bypass procedure, report a code from the 33510-33516 range. The heart surgeons at MASA perform coronary artery bypass grafting, valve replacement and repair, aortic surgery, repair of adult congenital heart disease, minimally invasive and off-pump surgery, and re-operative cardiac surgery. Pedicled grafts may also be used, where an artery is detached from its distal point and rerouted to the coronary arteries. After your coronary arteries have been exposed and a usable blood vessel segment has been harvested, your surgical team may place you on a heart-lung bypass machine. Forget the coding guidelines (at least temporarily) – let’s focus on the procedures first. As you think about Health Information Professionals Week, how will you celebrate? [2 points] 0210009 28 Using the ICD-10-PCS codebook build the code for Percutaneous transluminal coronary … In my view, the key to coding bypass procedures is knowing how blood is flowing, because that is what determines the “to” and “from” body parts to which the guideline refers. Distal flow into the LAD is good even after one and a half decades. This is most commonly achieved using the internal mammary arteries. Coronary artery bypass surgery, also known as coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery, is a surgical procedure to restore normal blood flow to an obstructed coronary artery. So, let’s briefly talk about anatomy and blood flow. Since two of the arteries had a different device and qualifier than the other, two codes are necessary when we apply coding guideline B3.6c. An arterial bypass is no different: there is a blockage we need to get around, and to do that, we must make a new pathway. The madness I’d like to address in this article relates to ICD-10-PCS coding guidelines for arterial bypass procedures. The ICD-10-PCS definition of the root operation Bypass is “altering the route of passage of the contents of a tubular body part.” In the case of the arterial system, the tubes are the arteries of the heart, as well as noncoronary circulation. Medical and Surgical, Lower Arteries, Bypass, Internal Iliac Artery, Right The Internal Iliac Artery, Right body part is identified by the character E in the 4 th position of the ICD-10-PCS procedure code. LAD stands for left anterior descending artery which is the artery commonly responsible for the ‘Widowmaker Blockage.” The aorto-coronary bypasses are coded differently in ICD-9-CM vs. ICD-10-PCS with ICD-10-PCS requiring separate codes for the different types of devices (i.e., autologous artery, autologous vein). Users who consider that data likely to be collected by Google is unacceptable, kindly do not continue on this site. Kristi Pollard is a senior coding consultant at Haugen Consulting Group. If you’re wondering why the body part and qualifier values for coronary arteries are reversed from every other type of bypass, the evidence is in the tables. Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. Here the LIMA graft is imaged in the lateral view. LIMA to LAD coronary bypass graft: LIMA (left internal mammary artery) is to date the most durable conduit for coronary artery bypass grafting. Please contact your physician for medical advice. The most well known bypass is called the LIMA to LAD. Does that sound a little harsh? Therefore, when re-perfusing the leg below the area of blockage, blood is coming from the femoral artery (fourth-character body part value) to the popliteal artery (seventh-character qualifier value). We do not endorse any products or services shown as ads. In ICD-10-PCS, there are two root operations for this procedure, Bypass and Excision. April 8, 2019, Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer, The 10-Year Coder Challenge: Growing Your Skills beyond CCs and MCCs, Song of a Story-Teller: Patient-Focused Coding, Feeling the Burn: Confessions of a Formerly Burned Out Coder, Cardiovascular and Vascular Interventional Radiology Specialization Improves Coding Performance, Beyond Training: Mentoring Coding Professionals, Understanding the Nuances of Coding Malnutrition, Arriving Soon: Code U09.9, Post-COVID-19 Condition, How to Code Administrative COVID-19 Testing, COVID-19 Coding Dilemma: Z20.828 and Z03.818, Screening for COVID-19: When to use Z11.59, HIP Professionals Honored in National Spotlight, Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, CCS-P, CDIP, Certified Clinical Documentation Improvement Practitioner, Evan M. Gwilliam, DC, MBA, BS, CPC, CCPC, CCCPC, NCICS, CPC-I MCS-P, CPMA, Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FC, Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer, Kim Carr, RHIT, CCS, CDIP, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer, Rhonda Buckholtz, CPC, CPMA, CPC-I, CRC, CDEO, CHPSE, COPC, CPEDC, CGSC, Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, AHIMA-approved ICD-10-CM/PCS Trainer, Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer, Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC, Wilbur Lo, MD, CDIP, CCA, AHIMA-Approved ICD-10-CM/PCS Trainer. The left internal mammary artery, or LIMA, is located on the left side of the heart. Blood flows from the aorta to the coronary arteries. Kristi is a member of the ICD10monitor editorial board and a popular guest on Talk Ten Tuesdays.