Wiki Effusion drainage with pleurodesis

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stacymac51488

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I have a provider who wants to add modifier 22 for draining a pleural effusion at the time of doing a pleurodesis. I don't see it documented that there was increased work, complexity, or time and the office manager is pushing back. Please see the below op note snip and all feedback is welcomed and appreciated!

"An incision was made about the 7th ICS in the posterior axillary line. A thoracic port was placed. The camera was introduced. There was a large amount of clear serous effusion within the chest 2.6 liters was evacuated. No masses were found on the lung or chest wall. 8g of talc powder was instilled into the chest using a clean septa syringe. 28fr CT was placed through the incision and secured to the chest wall. The incision was closed."

It's my understanding that the code for draining an effusion is 32601, which is bundled into 32650 for the pleurodesis and I don't see support of modifier 22. Thank you in advance!
 
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Legacy79 said:
Have you considered category 325 codes. I am getting codes 32551, 32554 - 32557 for pleural effusion draining.
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He drained the effusion at the time of vats pleurodesis, using thoracoscopy. This wasn't a chest tube insertion, thoracentesis, or percutaneous approach. I believe 32601 for the drainage is the correct code because of the vats approach.
 
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stacymac51488 said:
I have a provider who wants to add modifier 22 for draining a pleural effusion at the time of doing a pleurodesis. I don't see it documented that there was increased work, complexity, or time and the office manager is pushing back. Please see the below op note snip and all feedback is welcomed and appreciated!

"An incision was made about the 7th ICS in the posterior axillary line. A thoracic port was placed. The camera was introduced. There was a large amount of clear serous effusion within the chest 2.6 liters was evacuated. No masses were found on the lung or chest wall. 8g of talc powder was instilled into the chest using a clean septa syringe. 28fr CT was placed through the incision and secured to the chest wall. The incision was closed."

It's my understanding that the code for draining an effusion is 32601, which is bundled into 32650 for the pleurodesis and I don't see support of modifier 22. Thank you in advance!
Click to expand...
I agree with you I don't think a modifier 22 is valid based on that snippet of the op note. I would just bill 32650.

Per Vitalware cpt 32650 procedure description:

Surgical thoracoscopy, also referred to as video assisted thoracoscopic surgery (VATS), is performed for mechanical or chemical pleurodesis. Three small incisions are made, one at the 7th or 8th intercostal space along the mid-axillary line, one in the posterior chest wall under the tip of the scapula, and one in the anterior chest wall at the 5th or 6th intercostal space. A videothoracoscope is inserted through one of the incisions and surgical instruments are inserted through the other incisions. Alternatively, the procedure is sometimes performed through a single incision. When a single incision technique is used, the procedure may be referred to as a pleuroscopy and both the scope and surgical instruments are passed through the single incision. The pleura is inspected, a chest tube is placed, and the pleural space is injected with a chemical sclerosing agent that causes irritation and inflammation of the pleurae, causing them to adhere to each other. The chest tube is temporarily closed, allowing the sclerosing agent to spread through the pleural space. The chest tube is then opened and the sclerosing agent is suctioned out of the chest tube. Alternatively, the pleura can be mechanically abraded, which also causes inflammation resulting in the pleurae adhering to each other. The chest tube may be left in place for several days to allow fluid to drain from the chest.
 
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Legacy79 said:
I agree with you I don't think a modifier 22 is valid based on that snippet of the op note. I would just bill 32650.

Per Vitalware cpt 32650 procedure description:

Surgical thoracoscopy, also referred to as video assisted thoracoscopic surgery (VATS), is performed for mechanical or chemical pleurodesis. Three small incisions are made, one at the 7th or 8th intercostal space along the mid-axillary line, one in the posterior chest wall under the tip of the scapula, and one in the anterior chest wall at the 5th or 6th intercostal space. A videothoracoscope is inserted through one of the incisions and surgical instruments are inserted through the other incisions. Alternatively, the procedure is sometimes performed through a single incision. When a single incision technique is used, the procedure may be referred to as a pleuroscopy and both the scope and surgical instruments are passed through the single incision. The pleura is inspected, a chest tube is placed, and the pleural space is injected with a chemical sclerosing agent that causes irritation and inflammation of the pleurae, causing them to adhere to each other. The chest tube is temporarily closed, allowing the sclerosing agent to spread through the pleural space. The chest tube is then opened and the sclerosing agent is suctioned out of the chest tube. Alternatively, the pleura can be mechanically abraded, which also causes inflammation resulting in the pleurae adhering to each other. The chest tube may be left in place for several days to allow fluid to drain from the chest.
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Thank you for your feedback, this is helpful :)
 
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