CPT CODES ONLY NOT ICD-10 CODES PreoperativeDiagnoses: 1. Severe multivessel cor
ID: 138528 • Letter: C
Question
CPT CODES ONLY NOT ICD-10 CODES
PreoperativeDiagnoses:
1. Severe multivessel coronary artery occlusive disease with increasing angina.
2. Non-Q wave myocardial infarction.
3. Hypertension.
4. Hypercholesterolemia.
5. Non-insulin dependent diabetes mellitus.
Postoperative Diagnoses: Same.
Name of Procedure: Coronary artery bypass graft times three (left internal mammary artery to mid LAD, saphenous vein graft to intermediate and saphenous vein graft to distal right coronary artery).
Anesthesia: General endotracheal
History: This patient is a 72-year-old female with known coronary artery occlusive disease treated medi- cally. She has had increasing angina. She has multiple risk factors. Repeat catheterization showed rather significant progression of disease and recommendation was made for bypass grafting. Ventricular function was well-preserved and was normal. Description of
Operative Procedure: The patient was brought to the operating room. After having induced adequate general endotracheal anesthesia, she was prepared and draped in sterile fashion. This segment of saphenous vein was taken from the left thigh through multiple skin incisions. Adequate length of good quality vein was obtained. The
thigh was closed in layers with 2-0 and 3-0 Dexon over a tubular Jackson- Pratt drain. The chest was entered through a standard median sternotomy and systemic heparin admin- istered. She was cannulated for bypass with a catheter placed in the distal ascending aorta for perfusion and a venous return catheter in the right atrial appendage. Cardiopulmonary bypass was instituted. After achieving a systemic temperature of 30 degrees, the aorta was crossclamped. Cold potassium cardioplegia was instilled in the aortic root and topical ice saline placed on the heart. We bypassed the intermediate branch first. This was an intramyocardial 2.5 to 3 mm vessel. A segment of reverse vein was sewn end-to- side with 7-0 Prolene and then more cardioplegia instilled down the graft. Next, we bypassed the distal right coronary artery. This was a diffusely diseased vessel with a distal plaque. The distal plaque was bridged. A segment of vein was sewn end-to-side with 7-0 Prolene and again more cardioplegia instilled down the graft. We then sewed a nice size left internal mammary artery to the mid LAD with 7-0 Prolene. The cross- clamp was removed and a partial occlusion clamp was placed on the base of the aorta. Two aortotomies were made. The veins were cut to the appropriate length and. sewn to the aorta end-to-side with 5-0 Prolene, Vein graft to the right was placed superiorly and the vein graft to the intermediate inferiorly on the aorta. Cardiac action returned promptly in sinus rhythm. She was fully rewarmed, weaned from bypass and decannu- lated. Cannulation sites were reinforced with 3-0 Prolene. Protamine was administered. Hemostasis was assured. A temporary pacing wire was placed on the right ventricular surface. Two chest tubes were placed in the midline and secured to the skin with -0- Tevdek. The sternum was closed with multiple interrupted wire, linea alba with #1 Tevdek, presternal fascia with -0- Dexon, the skin with 4-0 subcuticular Dexon and Dermabond. She tolerated this procedure well, was returned to the CVR in stable condition.
What CPT codes are reported?
Explanation / Answer
The reported CPT codes are: 33533, 33518
The Current Procedural Terminology (CPT) code 33533 is under the range - Arterial Grafting for Coronary Artery Bypass.
The Current Procedural Terminology (CPT) code 33518 is under the range - Combined Arterial-Venous Grafting for Coronary Bypass.