How to Code CABG Procedures

(Using Upper and Lower Extremity Grafts)

In the medical coding world, coders consistently use their analytical skills to ensure physicians receive proper payment for their services and patients get billed correctly. However, coding for the cardiovascular system can be challenging, and one major challenge involves coding for a CABG. Therefore, let’s break down what a CABG is and how to code it when upper or lower extremity grafts are involved.

CABG stands for coronary artery bypass graft. In this procedure, the surgeon bypasses or reroutes a narrowed or blocked artery by using a graft harvested from the patient. In many cases, the graft may come from the upper extremities (arms) or the lower extremities (legs). Furthermore, surgeons may use an artery, a vein, or even both in a single CABG operation. As a result, the rerouting restores blood flow, delivering oxygen and nutrients to the heart muscle.

When coding combined upper and lower extremity grafts for a CABG, start by identifying both the number and type of grafts used. If the procedure involves both arterial and venous grafts, then apply the following guidelines.

• Report two codes. Use code range 33533–33536 for the arterial grafts first, based on the number of arterial grafts performed.
• If venous grafts accompany the arterial grafts, add codes from the 33517–33523 range to represent the number of venous grafts.

The procurement of the saphenous vein is already included in codes 33510–33523 and should not be reported separately. By contrast, harvesting of other veins and arteries is reported separately when used:

• +35500 for an upper extremity vein
• +33509, +35600 for an upper extremity artery
• +35572 for the femoropopliteal vein
  (CPT 2025)

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Example (CABG Procedures Using Upper and Lower Extremity Grafts)

A patient undergoes CABG with three arterial grafts to the left anterior descending (LAD), left circumflex artery (LCX), and left coronary artery (LCA). In addition, radial artery graft is placed to the posterior descending artery (PDA), and two venous grafts are also performed.

33535 for the three arterial grafts

+33518 for the two venous grafts

+35600 for the radial artery harvest

RESOURCES

American Medical Association. (n.d.). Surgery/ Cardiovascular System. In CPT 2022 Professional Edition (pp. 265–267). essay. 

Coronary artery bypass graft surgery. Johns Hopkins Medicine. (2024, April 15). https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/coronary-artery-bypass-graft-surgery 

Jackson, C. (2024). Cardiovascular System (33016-37799). In Medical Coding Guidelines Manual (pp. 404–404). essay. Retrieved July 11, 2025. 

About the Blogger:

Katoya Winston is a Surgical Resource Technician with 25 years of experience in the medical field, including both direct patient care and operating room expertise. Certified as a CCS (Certified Coding Specialist) and CPC (Certified Professional Coder), Katoya brings a strong blend of clinical and coding knowledge. Currently serving as an intern at Absolute Medical Coding Institute (AMCI), she continues to advance her expertise in medical coding and healthcare compliance.

www.amcicoding.com