Thoracoscopy

jrwood

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I have a physician that performs a thoracoscopy with wedge resection of lung, single or multiple (32657 with a modifier 58), wait for pathology and if warranted immediately perform a 32663 (lobectomy). I have two questions:

1. Is the physician coding this correctly?
32663 and 32657,58

2. Has anyone received any RAC audits for the use of these two codes together?

Thanks,
 

Pam Brooks

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32657 has been deleted for 2012. The VATS codes underwent many, many changes this year, by more completely separating the diagnostic and surgical VATS procedures, adding in lymphadenectomies, several new add-on codes, as well as indicating in revised text that you can't report a diagnostic VATS with a surgical VATS. If you can get your hands on a 2012 book, you can see that the changes are significant.

In 2012, you can bill a 32663 (lobectomy) with a diagnostic wedge resection +32668. (new add-on code).

If your surgery was done in 2011, I wouldn't bill the VATS wedge then the VATS lobectomy, even with resultant pathology. I would report the lobectomy with the -58, only if he opens. If not, bill the VATS lobectomy only.

The RAC hasn't really dug into physician surgical work that I'm aware of. We've had RAC requests primarily for our inpatient claims.
 
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