Endarterectomy During Coronary Artery Bypass

A coronary artery endarterectomy is not always performed during a CABG procedure, so when it is performed it becomes confusing as to whether to code it separately or not.

Questions to ask yourself when coding endarterectomy at same time as CABG:

• Is the endarterectomy performed to facilitate the anastomosis?
  Yes-don’t code
  No-separate code may be necessary
• Is the endarterectomy performed because of occluded and/or calcified vessels making the CABG technically impossible?
  Yes-don’t code
  No-separate code may be necessary
• Is the endarterectomy performed to make the CABG easier?
  Yes-don’t code
  No-separate code may be necessary
• Was there a separate and distinct objective for the endarterectomy?
  Yes-separate code may be necessary
  No-don’t code
• Is the endarterectomy performed on another vessel than the one that is being bypassed?
  Yes-separate code may be necessary
  No-don’t code

There may be other questions and scenarios that come up, but these are the common questions that coders should ask themselves while assigning PCS codes for CABG with endarterectomy. The most recent official coding advice from AHA Coding Clinic for ICD-10-CM/PCS, Third Quarter 2018: Page 26 states “when the endarterectomy is done to prepare the artery for the bypass surgery the endarterectomy would not be coded separately. The endarterectomy is only reported when there is a separate and distinct procedural objective.” This is very similar advice that we followed prior to ICD-10-CM/PCS implementation.

Authored by Kim Boy, RHIT, CDIP, CCS, CCS-P

References
AHA Coding Clinic for ICD-10-CM/PCS, Third Quarter 2018: Page 26
AHA Coding Clinic, Third Quarter 1993, Page: 7 to 8
ICD-10-PCS Official Guidelines for Coding and Reporting 2020, Page: 5 to 6

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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.