Lately we have seen several cases where the endarterectomy was assigned along with the coronary artery bypass (CABG) procedure when being performed on the same vessel to facilitate the CABG.
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.
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