02100Z9 Bypass Coronary Artery, One Artery from Left Internal Mammary, Open Approach

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 "Coronary Artery Bypass Grafting (CABG): PCS codes for a Comprehensive Procedure for Treating Coronary Artery Disease"


Discover the details of coronary artery bypass grafting (CABG), a surgical intervention aimed at treating coronary artery disease. Learn about the principal and secondary procedures involved, including bypassing blocked heart arteries using veins from the leg and chest. Explore the patient's preoperative and postoperative diagnoses, along with the anesthesia and surgical techniques employed. Gain insights into medical coding and billing information associated with CABG procedures.

Scenario 

PREOPERATIVE DIAGNOSIS: 1. Coronary Artery Disease (blocked heart arteries) 2. HTN (high blood pressure)


POSTOPERATIVE DIAGNOSIS: Same


OPERATION PERFORMED: 1. Coronary Artery Bypass grafting to the LAD, Ramus, OM, PDA, using LIMA and SVG. Bypasses - CABG x 4, LIMA->LAD, SVG->Ramus, SVG->OM, SVG->PDA

(Procedure to create new paths for blood around blocked heart arteries using veins from the leg and chest. Four paths were created: one from the leg vein to the front heart artery, and three from the chest veins to other heart arteries.)


Endoscopic vein harvest. (Minimally invasive procedure to remove vein from the leg.)

ANESTHESIA: General endotracheal anesthesia. (General anesthesia through a breathing tube.)


PROCEDURE: The patient was prepped and draped in sterile fashion. (The patient was prepared and covered in a sterile manner.) We performed a time-out verifying patient identity, site specific for surgery, procedure to be performed as well as appropriate perioperative antibiotic infusion which in this patient was Kefzol and Vancomycin. (We confirmed the patient's identity, the surgical site, the procedure to be performed, and administered appropriate antibiotics during surgery, specifically Kefzol and Vancomycin.) We further verified that the beta blocker had been administered orally this am. (We confirmed that the medication to control heart rate had been taken orally in the morning.) Following that we endoscopically extracted the greater saphenous vein from the right lower extremity. (Using a small camera, we removed the large vein from the patient's right leg.) Side branches were controlled. The vein was extracted and prepared for bypass. (Small blood vessels branching from the vein were controlled. The vein was removed and prepared for use in the bypass surgery.) The leg was made hemostatic, and then closed in layers with absorbable suture followed by Dermabond. (Bleeding in the leg was controlled, and the incision was closed in layers with dissolvable stitches, followed by a special adhesive called Dermabond.)


Simultaneously that we made an incision from the sternomanubrial junction to the xiphoid dissection carried that down through subcutaneous tissue to the sternum which was opened in its midline with a reciprocating saw. (At the same time, we made an incision from the top of the breastbone to the lower end, cutting through the skin and tissue to expose the breastbone, which was then opened in the middle using a saw that moves back and forth.) Periosteal bleeding was controlled with electrocautery and Gelfoam. (Bleeding from the bone covering was controlled using a device that uses heat and a special material called Gelfoam.) We opened the left pleural space using a rul-tract retractor to elevate the left hemi-sternum and we harvested the mammary artery with its concomitant veins from the level of the xiphoid to subclavian vein using a series of clips and electrocautery. (We used a specialized retractor to elevate the left side of the breastbone, then harvested the artery in the chest along with its accompanying veins, from the lower end of the breastbone to the vein in the neck, using clips and a device that uses heat.) After systemic heparinization it was doubly clipped distally, divided, and prepared for bypass, treated topically with papaverine and set aside. (After administering heparin throughout the body to prevent


MS DRG 235 Coronary bypass without cardiac catheterization with MCC 

Bill expected $42298

 APR DRG 165 Coronary bypass with AMI or complex principal diagnosis

 Principal Diagnosis  I214 Non-ST elevation (NSTEMI) myocardial infarction 

Secondary Diagnoses I2510 Atherosclerotic heart disease of native coronary artery without angina pectoris 

Principal Procedure 
02100Z9 Bypass Coronary Artery, One Artery from Left Internal Mammary, Open Approach

 Secondary Procedures 
021209W Bypass Coronary Artery, Three Arteries from Aorta with Autologous Venous Tissue, Open Approach 

02HV33Z Insertion of Infusion Device into Superior Vena Cava, Percutaneous Approach 

5A1221Z Performance of Cardiac Output, Continuous.

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