Amber Posted Mon 24th of June, 2019 20:40:10 PM
When doing the atrial appendage procedure (ligation and/or clip – not the watchman procedure), what are the documentation guidelines for the surgical dictation? These are done during other surgeries (CABG and/or aortic valve replacement,) and we are using CPT 33999 for treatment of chronic AF.
SuperCoder Answered Tue 25th of June, 2019 04:52:52 AM
Atrial appendage ligation is a procedure used to reduce the risk of stroke in patients with A-fib. During ligation, the appendage is permanently sealed off from the rest of the heart. This prevents blood from circulating through and pooling in your LAA and causing clots, potentially decreasing your risk of stroke.
During the ligation, doctor will apply the AtriClip to the outside surface of atrial appendage. The AtriClip will permanently close off the atrial appendage at its base and prevent blood from circulating through and pooling in the appendage. There are several devices that he can choose to use; two are the Watchman® and Amplatzer™ cardiac plug (ACP) devices. Exact technique varies with the different devices, but the basic steps are the same as descibed.
However, there is no such specified documentation require for this procedure, but the steps of procedure and language should be clear enough to support the intent and medical necessity.
Following example may be useful to understand the procedure language:
"The patient is appropriately prepped, which includes antibiotic prophylaxis to prevent postoperative infection, and placed under general anesthesia. He incises the skin over the femoral vein and introduces a catheter into the vein to obtain vascular access. He threads the catheter up through the vein and into the heart using fluoroscopic guidance. He uses a standard transseptal needle and sheath to pierce the septum (the wall between the chambers of the heart) to introduce the delivery system and access the left atrial appendage (LAA), a small ear–shaped sac in the wall of the atrium where blood can collect and clots form when the patient's heart does not contract properly. He may administer a large dose (bolus) of heparin to help prevent clots during the procedure. He may also use contrast angiography to visualize the left atrium and measure LAA dimensions (opening, width of neck, and depth), which he uses to choose the size of the implant device. He again uses fluoroscopy to position the device properly in the LAA cavity. He withdraws the sheath over the device and deploys the device in position. He performs a ‘tug test’ to confirm stability and verifies seating of the device. He releases the device from the delivery cable and rules out possible complications, such as bleeding, clot, and pericardial effusion. Upon completion of the procedure, the provider withdraws the catheter and closes the incision."
Make your intent and language clear, mention all steps of the procedure, because when reporting a procedure with an unlisted code (33999) payer will determine payment based on the documentation you provide. It is suggested to submit a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Also include the operative notes or other relevant documentation to strengthen the claim and to avoid a possible denial. Your payers will consider claims with unlisted procedure codes on a case by case basis.
Hope this helps!