L vats w/lll wege bx and partial decort

dvance4210

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A VATS was performed using 3 2cm incisions. The lower was completed just above the diaphragm, and the two upper were completed under direct vision. In the chest there were extensive adhesions between the lower lobe and diaphragm extendng up the posterior chest wall. We performed a decortication freeing the lower lobe up to the fissure. At this point, the nodule was identified and palpated. We resected it with an Echelon thorascopic stapling device which was inserted and placed across the base of the nodule leaving a 1 cm margin. The specimen was sent to the lab for histologic evaluation and frozen section came back consistent with granuloma.....

Dx: LLL pumonary nodule: 793.11 (pre-op and post-op)
I was going to use 32608-LT with 32651(partial decort) but I can't use the 32608 with the 32651 in the CCI edits. I want to bill for the wedge as well but didn't want to use the 32666-therapeutic wedge since the path came back as granuloma.

Any thoughts would be helpful.

Thanks,
 

jewlz0879

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All six diagnostic codes (32601-32609) are bundled with the surgical thoracoscopies (32650-32674). Diagnostic thoracoscopies should not be billed if a surgical thoracoscopy is performed during the same session, unless the diagnostic procedure resulted in the decision to perform surgery, then you can attach modifier 58.

On the other hand, multiple surgical thoracoscopies are not bundled with each other. If two separate techniques are performed at different sites, both may be billed with modifier 59.

The decortication makes it surgical however, the diagnostic procedure 32608 did not result in reason for surgery. It seems like the nodule was removed but maybe I'm interpreting that wrong. Based on that, I would bill:

32666
32651-59

HTH
 

dvance4210

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Thanks for the info...so regardless of the path on the wedge, if the nodule is removed, it is considered a therapeutic wedge, right?
 
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