PLEASE HELP - New to Surg Coding: Thoracotomy/Thoracoscopy

jewlz0879

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I have a pt where the physician did two things:

1. Video assisted thoracopic surgery with lysis of lung adhesions

2. Left Anterior Thoracotomy with resection of 4th anterior rib/chest was resection/

A thoracoscopy evalution of the left chest; there was an exophytic lesion noted in the 4th rib. This was marked. In addtion, there were adhesions to the mass that were taken down bluntly using the camera. These adhesions were filmy; the filmy adhesion were taken down. The pleura encasing the exophytic rib mass was intact. At this point, with the incision planned, the camera was withdrawn and a 10 blade was then used to make an anterior thoracotomy inscision. The 4th rib was identifed clearly as the chest space was entered and cautery was then used to expose the 5th rib anteriorly as well as the 3rd inferiorly. A rib shear was used to transect the rib posteriorly to free up the posterior margin. Then rib shear was used to transect the 4th rib posteriorly. Again cautery was used to to expose the rib with adequate 2cm margin beyond the mass. The rib shear was then used to transect the 4th rib anteriorly. The mass was freed up and collected for specimen for frozen section....
__________________________________________________________________________

I was thinking:

32650
AND
19260 but I'm not confident because I'm not sure the 19260 includes the right approach (thoracotomy).

Any suggestions, Coding tips? Or am I WAY off in left field here???

Thank you!
 

lisigirl

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Oakpark, Illinois
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CPT 19260 includes resection of part of the chest wall, did the surgeon do that? If not, maybe you want to look at 21600?

I also would not bill 32650. For one, it sounds like the thoracoscopic incision was converted into an open thoracotomy and so you would only bill the more extensive procedure. Secondly, 32650 is for pleurodesis not pneumonolysis. Pleurodesis is actually the formation of adhesions, not taking them down.

If no chest wall was resected, I would probably bill 21600-22. The 22 would account for both the lysis of adhesions and the fact that the entire rib was taken.

Lisi, CPC
eharkler@nmh.org
 
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