Release of a Coronary Artery
With a myocardial bridge, part of a coronary artery dips into and underneath the heart muscle and then comes back out again. For the most part, a myocardial bridge is harmless. Patients with a myocardial bridge have it from birth, and most never know they have the condition. However, some patients can develop myocardial ischemia because of a myocardial bridge. Symptoms most likely caused by the myocardial ischemia may include:
- Chest pain
- Tightness in the chest or a feeling of pressure or heaviness on the chest
- Pain the left arm or jaw
- Shortness of breath
In most patients, a myocardial bridge is not treated if it is not causing any symptoms. In patients with symptoms, medicines such as beta-blockers and calcium channel blockers are usually the first line of treatment. In rare cases, patients need surgery to relieve their symptoms. Surgery involves removing the bridge (muscle) that is pressing on the coronary artery. The Second Quarter 2019 Coding Clinic provides advice the root operation for “unroofing an anomalous right coronary artery is release” and the PCS code assigned is 02N00ZZ Release coronary artery, one artery, open approach. In this case, the documentation specifies that the patient has an “anomalous origin to the right coronary artery.” And in this case a PCS code is assigned for the release along with the appropriate CABG codes.
Keep in mind that during CABG surgery, the surgeon may divide the myocardium to expose the bypass anastomosis site on the coronary artery in the absence of an anomaly or myocardial bridging. As stated in the Second Quarter 2013 Coding Clinic exposing a coronary artery surrounded by cardiac muscle that is a natural variation in human anatomy is considered integral to the procedure and not separately reported.
To summarize, when determining whether or not to report a procedure code for releasing a coronary artery look for provider documentation that identifies myocardial bridging or another anomaly of the coronary artery.
Second Quarter 2019 Coding Clinic Unroofing of Anomalous Coronary Artery (P. 13)
Second Quarter 2013 Coding Clinic Coronary Artery Release Performed During CABG (P. 37)