Wiki Case #18 Winner, Answer Key, & Rationale

[alex.mckinley@aapc.com]

Chelsi T. wins again! View case #18 answers and rationale below.

ANSWERS
CPT: 32650
CPT Modifiers: none or RT
ICD-9: 511.9, 162.9

RATIONALE
The provider performs a pleurodesis via VATS (video-assisted thoracic surgery). The lysis of adhesions is not reported separately. We accepted answers for modifier RT but it was not required.

The patient is diagnosed with recurrent pleural effusion and stage IV lung cancer. Although it is very likely that the pleural effusion is caused by the cancer, the provider does not document as malignant. Because pleural effusion can have more than one cause, without the provider indicating the cause we have to code with 511.9. If the pathology report was available and reviewed by the provider, we could also determine if the pleural effusion was malignant or not. This would definitely be a good case for documentation improvement and feedback for the provider.

CPT: 32650 or 32650-RT

Steps to look up: Pleurodesis/Thoracoscopic

ICD-9-CM: 511.9, 162.9

Steps to look up: Effusion/pleura; Neoplasm/lung/malignant/primary

 

[lec121661]

case#18

Chelsi T. wins again! View case #18 answers and rationale below.

ANSWERS
CPT: 32650
CPT Modifiers: none or RT
ICD-9: 511.9, 162.9

RATIONALE
The provider performs a pleurodesis via VATS (video-assisted thoracic surgery). The lysis of adhesions is not reported separately. We accepted answers for modifier RT but it was not required.

The patient is diagnosed with recurrent pleural effusion and stage IV lung cancer. Although it is very likely that the pleural effusion is caused by the cancer, the provider does not document as malignant. Because pleural effusion can have more than one cause, without the provider indicating the cause we have to code with 511.9. If the pathology report was available and reviewed by the provider, we could also determine if the pleural effusion was malignant or not. This would definitely be a good case for documentation improvement and feedback for the provider.

CPT: 32650 or 32650-RT

Steps to look up: Pleurodesis/Thoracoscopic

ICD-9-CM: 511.9, 162.9

Steps to look up: Effusion/pleura; Neoplasm/lung/malignant/primary

could you have not used the 22 modifier for the lysis of adhesions? it stated it was difficult due to adhesions or did I read wrong. and would you code the 162.9 primary?

 

[jan g]

Case 18

I have this case coded correctly using modifier RT but did not get credit for it.
Please check. Thank you. Jan Goar

 

[ajgibson]

I have this case coded correctly using modifier RT but did not get credit for it.
Please check. Thank you. Jan Goar

Jang, on the leaderboard page, it says the results are 24-48 hours behind the cases. So the earliest you would see your new point reflected would be tomorrow.

 

[cmontyrn]

Case # 18 clinical added to Answer key & Rationale

Case # 18 clinical added to Answer key & Rationale
Since the clinical info wasn't included in posting of answer & rationale; and the link to case clinical info given now is not accessible (error page shows up) .... I thought it wise to include the missing clinical info.

Case #18 answers and rationale below.

ANSWERS
CPT: 32650
CPT Modifiers: none or RT
ICD-9: 511.9, 162.9

RATIONALE
The provider performs a pleurodesis via VATS (video-assisted thoracic surgery). The lysis of adhesions is not reported separately. We accepted answers for modifier RT but it was not required.

The patient is diagnosed with recurrent pleural effusion and stage IV lung cancer. Although it is very likely that the pleural effusion is caused by the cancer, the provider does not document as malignant. Because pleural effusion can have more than one cause, without the provider indicating the cause we have to code with 511.9. If the pathology report was available and reviewed by the provider, we could also determine if the pleural effusion was malignant or not. This would definitely be a good case for documentation improvement and feedback for the provider.

CPT: 32650 or 32650-RT

Steps to look up: Pleurodesis/Thoracoscopic

ICD-9-CM: 511.9, 162.9

Steps to look up: Effusion/pleura; Neoplasm/lung/malignant/primary



Hint: This case is an endoscopic procedure for a lung cancer patient.


Case #18

Preoperative Diagnosis: Recurrent Pleural effusion, Stage IV lung cancer

Postoperative Diagnosis: Recurrent Pleural effusion, Stage IV lung cancer

Procedure Performed: Right video assisted thoracoscopy, lysis of adhesions, talc pleurodesis (cpt 32650)

Procedure: Patient was brought to the operating room and placed in supine position. IV sedation and general anesthesia were administered per the Anesthesia Department. A double-lumen endotracheal tube was placed per Anesthesia. Position was confirmed by bronchoscopy. The patient was placed in the decubitus position with the right side up. The chest was prepped in the standard fashion with ChloraPrep, sterile towels, sheets and drapes. We had excellent isolation of the lung. However, we had poor exposure because there were a number of fibrous adhesions, a few of which were actually very dense. We immediately evacuated approximately 700 ml of fluid. However, once we entered the chest we encountered a number of loculated areas. We did not break down the adhesions. We gained enough exposure to do a complete talc pleurodesis. After lysing of adhesions, we were confident that we had access to the entire thoracic cavity. Eight grams of talc were introduced into the right thoracic cavity and strategically placed under direct vision. The chest tubes were then placed. The wounds were closed in layers. The patient tolerated the well and was taken to the recovery room in stable condition.

https://www.aapc.com/code/aapc-coding-challenge/cases.aspx