Coding Help Desk Addresses Common Questions, Scenarios

STS News, Summer 2013 -- Every cardiothoracic surgeon wants to maximize his/her reimbursement within the prescribed payer rules. And while the intricacies of coding may seem complicated, the best outcomes are often achieved when the surgeon is informed and works in tandem with the office billers.

The following represent a recent sampling of questions and answers from the STS Coding Help Desk.

General Thoracic Surgery
Question: A patient had an adenocarcinoma of the left lower lobe of the lung and an undiagnosed nodule of the left upper lobe. A thoracotomy with a left upper lobe wedge resection and a left lower lobectomy were performed. What are the correct codes that should be used to report this procedure?

Answer: For this scenario, report code 32480 – “removal of lung, other than pneumonectomy; single lobe (lobectomy)” as the primary code and code 32505-59-51 – “thoracotomy; with therapeutic wedge resection (e.g., mass, nodule), initial” as the secondary code.

These codes are bundled in the Medicare National Correct Coding Initiative (NCCI) edits; however, in this scenario, the procedures are performed in different lobes, so both may be reported and modifier -59 should be appended to the wedge resection (32505) to pull it out of the bundle. Modifier -51 communicates that the same physician performed multiple procedures in the same session, and the secondary procedure (32505) is subject to the multiple procedure discount.

Adult Cardiac Surgery
Question: According to NCCI edits, codes 33860 – “ascending aortic graft with cardiopulmonary bypass includes valve suspension when performed” and 33870 – “transverse arch graft with cardiopulmonary bypass” are bundled procedures. If an ascending aortic graft procedure (codes 33860 – 33864) extends anatomically into the transverse aortic arch but the anastomosis remains proximal to the origin of the innominate artery (e.g., a hemi-arch), can code 33870 be reported separately?

Answer: Code 33870 is bundled into all of the ascending aorta graft procedures (33860 – 33864). For procedures that involve reimplantation of the head vessels—either as an island pedicle or individually—the -59 modifier should be appended to code 33870 to pull it out of the bundle. The edit is to ensure that 33870 is not reported for situations where a hemi-arch repair is done and the head vessels are not involved in the procedure.

Congenital Cardiac Surgery
Question: Is a Sano shunt (code 33608 – “repair of complex cardiac anomaly other than pulmonary atresia with ventricular septal defect by construction or replacement of conduit from right or left ventricle to pulmonary artery”) separately billable with a Norwood, code 33619 – “repair of single ventricle with aortic outflow obstruction and aortic arch hypoplasia (hypoplastic left heart syndrome) (e.g., Norwood procedure)”?

Answer: No. The shunt (33608) is considered part of the Norwood procedure (33619), regardless of how it is accomplished. The use of the Sano shunt is just a modification of how the shunt in a Norwood is accomplished and is already valued into the work of the Norwood.

Evaluation & Management (E&M) Services
Question: Can the cardiothoracic surgeon bill for critical care services after a procedure?

Answer: Critical care provided by the surgeon and members of the same specialty in a group practice is considered part of the Medicare global surgical package and should not be separately reported. The majority of cardiothoracic procedures have a 90-day global period, and critical care related to the original procedure is already included in the payment and thus is not separately billable.

It is important to pay attention to the global period associated with a procedure. Not all global periods are 90 days. For instance, ventricular assist device (VAD) procedures (33975 – 33983) have an XXX global period, so critical care provided for these procedures can be reported separately, starting the same day once the patient is out of recovery.

The new transcatheter aortic valve replacement (TAVR) codes (33361 – 33365, 0318T) have a 0-day global period, so critical care can be reported separately starting the day after the procedure. However, if a VAD or TAVR procedure is performed with another 90-day global procedure in the same session, the ability to report critical care changes.

The diagnostic thoracoscopy (VATS) codes (32601 – 32609) also have a 0-day global period; therefore, separately billing critical care or other E&M services is allowed when performed.

Cardiothoracic Global Period
Question: Can you bill for placement of a percutaneous femoral arterial line when inserted by the surgeon?

Answer: Any catheter and/or line placements that are used for monitoring or access related to the procedure are considered part of the surgeon’s global surgical package and should not be separately reported.

For more help with coding questions, contact the STS Coding Hotline at (303) 209-7358.

© CPT code descriptors copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

The material presented here is, to the best of our knowledge, accurate and factual to date. The information and suggestions are provided as guidelines for coding and reimbursement, however, and should not be construed as organizational policy. The Society of Thoracic Surgeons disclaims any responsibility for the consequences of actions taken, based on the information presented in the Coding & Reimbursement Corner section of this website.

Get answers to complicated coding questions by attending the STS Coding Workshop, November 7–9 in Orlando. The workshop will include information on the upcoming ICD-10 transition, Medicare coding, cardiothoracic evaluation & management coding, and detailed coding issues for adult cardiac, general thoracic, congenital heart, and vascular surgery. Learn more at and encourage your billing staff to attend as well.