RhondaJohnson
Contributor
Hello,
I am looking at an op-note and I'm having trouble deciding on a code. I have narrowed it down to:
32220 - Total decortication lung - separate procedure
32200 - Drainage through chest wall.
The MD says the "decorticated" the lung, but for the CPT code 32220 it sounds like it has to be a major thoracotomy to perform such a procedure. And in his note he mentions only a 2 inch incision between the ribs.
Here is the note:
NARRATIVE DESCRIPTION OF OPERATION: 71-year-old nursing home patient presenting to the emergency room with fatigue, low-grade temperature. CT scan showed large left empyema with total lung collapse. I was consulted for surgical recommendation. After talking to the son of the patient because of his very malnourished state and high risk of procedure, the son of the patient verbalized understanding and gave me the authority to proceed with surgical recommendation. The patient was brought in the operating room, was placed in supine position. General anesthesia with endotracheal intubation was achieved. An arterial line peripheral line was used to monitor the hemodynamics of the patient. Patient was placed in right lateral decubitus left side up. The study field was prepped and draped in the usual fashion over the chest, left lung. A minithoracotomy, 2 inches long, was performed between the posterior and the mid axillary line at the level of the 5th intercostal space. The chest cavity was entered and 1500 mL of yellowish, thick, purulent material was drained from the chest cavity. After careful profuse irrigation with antibiotic solution, vancomycin and Ancef, the left upper lobe was carefully decorticated and evidence of multiple abscesses in the left lower lobe was identified. These were drained in the best possible satisfactory manner. At this point, again, irrigation was performed. The 3 chest tubes, 36-French, 2 straight anterior-posterior all the way to the apex and 1 curved angle at the base. At this point, the ribs were approximated with Vicryl #1. Vicryl #0 were used for the fascia and the subcutaneous, 2-0 Vicryl were used for the subcutaneous, and 4-0 Monocryl were used for the skin. The patient tolerated the procedure. At the end of the procedure, the counts were correct. The complications were none. The patient was transferred to the medical ICU stable, intubated.
Thanks for any help you can offer.
I am looking at an op-note and I'm having trouble deciding on a code. I have narrowed it down to:
32220 - Total decortication lung - separate procedure
32200 - Drainage through chest wall.
The MD says the "decorticated" the lung, but for the CPT code 32220 it sounds like it has to be a major thoracotomy to perform such a procedure. And in his note he mentions only a 2 inch incision between the ribs.
Here is the note:
NARRATIVE DESCRIPTION OF OPERATION: 71-year-old nursing home patient presenting to the emergency room with fatigue, low-grade temperature. CT scan showed large left empyema with total lung collapse. I was consulted for surgical recommendation. After talking to the son of the patient because of his very malnourished state and high risk of procedure, the son of the patient verbalized understanding and gave me the authority to proceed with surgical recommendation. The patient was brought in the operating room, was placed in supine position. General anesthesia with endotracheal intubation was achieved. An arterial line peripheral line was used to monitor the hemodynamics of the patient. Patient was placed in right lateral decubitus left side up. The study field was prepped and draped in the usual fashion over the chest, left lung. A minithoracotomy, 2 inches long, was performed between the posterior and the mid axillary line at the level of the 5th intercostal space. The chest cavity was entered and 1500 mL of yellowish, thick, purulent material was drained from the chest cavity. After careful profuse irrigation with antibiotic solution, vancomycin and Ancef, the left upper lobe was carefully decorticated and evidence of multiple abscesses in the left lower lobe was identified. These were drained in the best possible satisfactory manner. At this point, again, irrigation was performed. The 3 chest tubes, 36-French, 2 straight anterior-posterior all the way to the apex and 1 curved angle at the base. At this point, the ribs were approximated with Vicryl #1. Vicryl #0 were used for the fascia and the subcutaneous, 2-0 Vicryl were used for the subcutaneous, and 4-0 Monocryl were used for the skin. The patient tolerated the procedure. At the end of the procedure, the counts were correct. The complications were none. The patient was transferred to the medical ICU stable, intubated.
Thanks for any help you can offer.