Question bronchoplasty


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My provider performed surgery on a patient. She had bronchoscopy, VATs, Robotic assisted Rt lower lobectomy, and lymphadenectomy. But, prior to closing, "a tear was encountered in the right upper lobe bronchus necessitating bronchoplasty repair" The operative report says that he decided to convert to an open procedure, he "undocked the robot and performed a small posterolateral thoracotomy preserving the serratus anterior muscle and cutting a very atrophic latissimus dorsi muscle....further identification of this are confirmed that there was a tear of the right upper lobe bronchus and the posterior ascending artery was nowhere in sight in this area. We therefore repaired this with interrupted monocryl 4-0 sutures and spaced these apart. once we did that we allowed the lung to ventilate and there appeared to be good ventilation."

The only codes that come close are 1) 32501 : however that is an add-on to 32480-32484 which were not done. 2) 31770 is with a graft repair, but this was repaired w/sutures not graft.

I'm thinking that maybe I will have to go with the unlisted code 31899 and include a description and state that its comparable to 32501. Any ideas?input? Thanks!


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Hi - sorry for the delayed response. Is it clear from the op note if the tear occurred as a result of surgery or was something pre-existing? If the tear was caused by the underlying disease/pre-existing and not as a result of the surgery, I would agree with your thought on an unlisted 31899 linked to the fee of 32501 (that procedure represented by 32501 is more extensive than what happened but it's a good starting point for pricing). If the tear occurred during surgery, which seems more likely, I would consider it bundled. The reason I would consider it bundled is based on this guideline from the NCCI Policy Manual, Chapter 5, section E.3: Treatment of an iatrogenic complication of surgery such as a splenic laceration is not a separately reportable service. So if the surgery resulted in an unintended injury, fixing that unintended injury is bundled to the main surgery.

I hope that helps :)