Ask Dr. Z

I’m trying to understand question ID #12035 that states an AtriClip is considered part of a CABG, as well as question ID #9209 that states the same with CPT guidance “If excision or isolation of the LAA by any method, including stapling, oversewing, ligation or plication is performed in conjunction with any atrial tissue ablation and reconstruction (Maze) procedures it is considered part of the procedure”. In the below case, would you code 33999 for the atriclip ligation, and if not, as an ablation or MAZE is not performed as stated in the CPT ref, what ref do I use and or how do I explain this to the surgeon? "DX: Severe symptomatic multivessel CAD OP: CABG x4, left IMA to LAD, radial to PDA (proximal radial to aorta), saphenous vein graft to diagonal-1 (proximal saphenous vein graft to aorta), saphenous vein graft to obtuse marginal (proximal saphenous vein graft to aorta). ADDENDUM PX: Because of the patient's history of atrial flutter and need for anticoagulation, the left atrial appendage ligation was performed utilizing a #40 mm AtriClip."