Wiki help coding thoractomy

[dhorne27]

posterolateral thoracoctomy tube thoracostomy with water seal right angled basilar during open thoractomy single straight posterior placement during open thoracotomy I coded 32098-22, 32035-59 and 32551-59, i only got reimbursed for the 32035 and they took the multiple procedure discount??? thanks for any input

 

[cpc2007]

It may be helpful if you posted the body of the operative report without patient information which would allow myself or someone else to confirm that the 32035 is supported. I don't actually see anything in your short description of the procedure about removing a rib to allow continuous drainage of empyema (infection in the pleural space). Presuming 32035 is actually supported, though, the insurance company is correct not to pay 32098 or 32551 on the same side of the chest separately. 32098 bundles to 32035 as part of the "standards of medical/surgical practice." In the NCCI Policy Manual it states that biopsies performed at the site of more extensive open procedures including otomies, ectomies, etc. should not be reported separately. The only exception to this rule is if the biopsy is performed and the results of the biopsy determine the need to perform a more extensive procedure (which is somewhat rare). With the chest tube, the NCCI Policy Manual, Chapter 5, section C.16 states "A tube thoracostomy (CPT code 32551) may be performed for drainage of an abscess, empyema, or hemothorax. The code descriptor for CPT code 32551 defines it as a “separate procedure”. It is not separately reportable when performed at the same patient encounter as another open procedure of the thorax unless it is performed in the thoracic cavity contralateral to the one entered to perform the open thoracic procedure." So if the chest tube is on the same side of the chest as the rib resection with empyema drainage, you cannot report 32551 (you can only report 32551.59 if the chest tube is placed on the opposite side of the chest).

I hope that helps - have a good night!

Kim
www.codingmastery.com