thoracic surgery lung cancer

sbetts

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I'm new to coding thoracic surgeries and would appreciate any input on how to code the following case. (condensed report)

Pre-op diag: Known right lower lobe, nonsmall cell carcinoma lung; questionably involved mediastinal lymph nodes and/or left lingular nodule (PET/CT findings)

Due to PET/CT findings, it was decided patient should undergo operative staging(for treatment purposes).

Patient placed supine...Diagnostic bronchoscope was brought to the field and diagnostic bronchoscopy was performed. (31622-59) Tracheal anatomy was normal... Carina was sharp with normal.... No endobronchial lesions seen... Mild secretions seen... The double-lumen endotrachael tube was in good position.

Patient transferred to decubitus with left side up. 15mm thoracoport site was introduced along the left midaxillary line, approx 7th intercostal space. Intro of thoracoscope revealed relatively normal appearing lung. Thoracoscope was used to direct a small 3 inch incision over the site where the mass was predicted by PET scan. A portion of the 7th rib was resected to maximize exposure and minimize skin incision and decrease chance of iatrogenic injury to the ribs with rib spreading. (21600-59)

Through the minithoracotomy, the lingula was brought to the field and the mass appreciated. This was resected as a wedge resection with sequential firings of the GIA endocopic stapler. (32505 OR 32097) Thoracoport was removed and 36 french chest tube placed. The wound was closed.

Patient transferred back to supine. Incision was made above the sternal notch. Pretracheal space was digitally explored. Mediastinoscope was then brought to the field. Generous biopsies were taken of both 4R, 4L and also station 7 subcarinal lymph nodes and sent to pathology for analysis. Wound was closed. (38746 OR 39400)

Thank you!

Shena Betts,CPC
Physician's Professional Mgmt
 

jewlz0879

True Blue
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32505 for the thoracotomy with wedge resection; I would only use 32097 if he just did biopsies and did not acutally remove or resect a wedge.

39400 since 38746 is done by thoractomy.

HTH
 
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