Lobectomy with Arterioplasty

sechong11

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Hello, hoping someone can help me with this question. Patient underwent lobectomy with arterioplasty. Can I bill for the pulmonary arterioplasty? If so, what code? I was looking at CPT 35216 or should I just add a modifier -22. Any thoughts? Thanks.


The node which was PET avid on the CT scan was very enlarged and quite bulky causing compression of the truncus branches. I thought that trying to place a stapler on these PA would cause to tear. I therefore decided to remove the robotic instruments and made a open thoracotomy over 5th rib. I then retracted the lung posteriorly exposing the anterior hilum. The anterior hilar pleura was opened and the upper lobe vein was dissected and divided using a stapler. I then tried to free the space between the main PA and the upper lobe bronchus. The node was so large and truncus branches were stretched thin. I therefore dissected at the hilum, getting around the main PA and placed a vessel loop around just in case of major bleeding while trying to divided the PA. I then decided to clamp the main PA to decompress it and carefully dissect around individual branches, tied them using 4.0 silk and prolene sutures and divided them. The node was chiseled off the main PA carefully. The capsule of the PA was intact and no gross invasion was seen on the bronchus or the PA. Finally, the node was freed off along with the lung. The right upper lobe bronchus was then dissected around, and divided using a stapler. The posterior branch and lingular branch of the PA was also divided. The lung parenchyma at the fissure was then divided using a stapler. I then felt around the lower lobe of the lung.
 

cpc2007

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Since this work occurred to free the lobe of the lung and the nodes around it and not due to an issue with the artery itself, I would add the 22 modifier on the lobectomy.

Kim
www.codingmastery.com
 
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