Conduit Creation to Facilitate Cardiopulmonary Bypass
The work of placing a patient on cardiopulmonary bypass to accomplish a cardiac procedure is included in the work of the primary procedure, unless otherwise indicated in the code (for example: 33300 – Repair of cardiac wound; without bypass). However, there are situations in which central cardiopulmonary bypass is contraindicated (such as ascending aortic atherosclerotic disease) and the ascending aorta cannot be cannulated, so peripheral cardiopulmonary bypass is required.
For peripheral cardiopulmonary bypass in which the cannula(s) is placed directly into the artery (femoral, iliac, axillary, other), the placement of the cannula(s), initiation of bypass, cannula removal, and suture repair of the vessel(s) are included in the primary procedure. No additional codes may be reported.
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However, when direct cannulation of the peripheral artery is felt to be ill-advised, a graft conduit, anastomosed directly to the peripheral artery for purposes of accomplishing cardiopulmonary bypass, may be required. The work of creating the graft conduit for initiation of cardiopulmonary bypass, as well as the cutting or oversewing of the graft stump with sutures when cardiopulmonary bypass is no longer needed, may be reported separately. Example: The axillary artery is surgically exposed. After heparinization, a graft is sewn to the axillary artery. The graft is connected to an arterial cannula, a venous cannula is placed (centrally and/or peripherally), and cardiopulmonary bypass is established. The cardiac procedure is performed. After the cardiac procedure is accomplished, the patient is weaned from cardiopulmonary bypass. The axillary artery graft is clamped and cut as short as possible. The graft stump is closed with sutures. Currently, with the exception of the TAVR and ECMO codes, there is no code to report the creation of a graft conduit to facilitate arterial access. In order to report this service, the unlisted code 33999 – Unlisted procedure, cardiac surgery should be used.
Creation of the graft conduit is included in the work of the TAVR procedures (33361-33369). To report this service in conjunction with ECMO, use add-on code 33987 – Arterial exposure with creation of graft conduit (eg, chimney graft) to facilitate arterial perfusion for ECMO/ECLS (List separately in addition to code for primary procedure) (Use 33987 in conjunction with 33953, 33954, 33955, 33956).
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