Need Help! New to CT coding

jtb57chevy

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Physician excised a large mediastinal mass w/left & right paraphrenic nodes and thymic tissue due to a thymic carcinoid. Approach was through a sternotomy. Left internal mammary branch was supplying tumor, so this was ligated.

My first thought was 60521 or 60522, but I don't know the difference between the two - what constitutes a "radical" mediastinal dissection? I've also looked at 39220, but the 2012 Coder's Desk Reference describes that as a through the rib cage approach, which this wasn't.

Any help on this will be greatly appreciated.
 

Grintwig

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According to my Cardiothoracic Surgery Companion the difference between 60521 and 60522 is in 60522 the mediastinum is dissected.
This is the explanation under those two codes:
The physician removes part or all of the thymus gland. The physician exposes the thymus via a sternal split or transthoracic approach. The sternum is retracted and strap muscles separated. The superior lobe of the thymus is separated from the inferior aspect of the thyroid. The blood supply to the thymus is dissected free from the pericardium and removed. In 60522, the mediastinum is dissected. In both procedures, the incision is closed.

Without reading the OP note it is hard to advise on the appropriate code but maybe the description above will help you make your decision.
 
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