Wiki Immediate re-opening of Thoractomy due to air leak

rpettigrewcpc

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Patient had an extensive open therapeutic wedge resection 32505 (Modifier 22 used as it took 2 hours to free the lung from adhesions).

Immediately after closing the chest, the surgeon noticed an extensive airleak and reopened the chest and repaired it.

I need help on how to code the reopening/repair please????? CPT 32120 is what I initially looked at, but I believe the patient has to actually have left the operating room to use this.

Thoughts / Help?

Relevant portion of the Operative Report:
After the thoracotomy incision was closed and dressed, I noted that there
was a massive amount of air leak coming through the Pleur-Evac. I
expected air leak because of the extensive lysis of adhesions, but this
was quite substantial. I elected to reopen the thoracotomy incision to
explore and perhaps control some of the air leak. The staplers were
removed and the thoracotomy incision was reopened and a Finochietto
retractor was replaced. The chest cavity was filled with warm saline
solution and I noted some areas that had quite a bit of air leak. A 3-0
Vicryl was used to oversew these areas and topical Progel was applied
generously at these areas. The thoracotomy incision was then closed back
in a similar fashion as above. This time I noted that there was far less
air leak in the Pleur-Evac. The patient was then transferred to the
recovery room in stable condition. Instrument, sponge and needle counts
were correct at the end of the operative procedure.
 
that's a super tough call. I've never come across a situation like this but I can tell you that we rarely bill for repairs of lacerations caused by the surgeon. If he made a mistake then he should fix it for free and not get paid for it. I don't know if the patient has to leave the OR or not to be able to bill 32120 but it definitely seems like your best code if you do decide to bill something.
 
Thank you for your reply J.Monday.

I think what I've decided to do is go ahead and bill 32120 as a reduced services code and then send the operative report with it.
 
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