quick ??'s on short op note for thorascopic eval/plueral bx/thoracotomy/talc

mshaw530

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Grand Rapids, MI
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Looking for insight on a few things:
The limited (3 cm) thoracotomy to repair venous bleeder on lung.. all the thoracotomy codes I find describe a wide incision. Code ideas?
And the way I read the op note, I can't distinguish if the talc was instilled via thoracoscopic or thru the limited thoracotomy site?

32609- Thoracoscopy; with biopsy(ies) of pleura
32650-Thoracoscopy, surgical; with pleurodesis (eg, mechanical or chemical) *Which would then include the above code
or would it be
32560?

Procedure performed:
Thorascopic eval of the left chest, bx of pleural implants, limited left lateral thoracotomy to control bleeding from the lung parenchyma, talc pleurodesis.

Tech:
A 5mm port was introduced in the mid axillary line overlying the seventh interspace. The pleural fluid bubbled through the port. About 1 liter of fluid was evacuated and the portion submitted for cytology. A 2nd port was created in the posterior line in the 6th interspace. Exam of the pleural space showed multiple loculations. There were implants on the lower aspect of the anterior chest wall which were biopsied and submitted for permanent section. During the course of the evaluation, copious bleeding was noted from the 2nd port entrance site. A 3 cm incision was created, allowing exploration of the pleural space. A venous bleeder on the surface of the lung was identified and ligated. No other bleeding found. Marcaine was infiltrated through both port access sites. Two 4 g vials of talc were instilled into the pleural space. A 24-french blake drain was placed through one of the port access sites.
 
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I'm not sure if this is right or not, but I'd try 32609, 32560 (with the appropriate mod). The op note reads to me as the talc being instilled after the procedures, particularly because it's listed after the administration of the Marcaine.

What codes have you come across for the thoracotomy?
 
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