VAt Wedge of blebs & pleurodesis

dpumford

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Hello: Our physician states he did an Rt video-assisted thoracosopic surgery, wedge resection of multiple blebs of Rt Upper Lobe plus Superior Segment of Rt Lower Lobe plus mechanical and talc pleurodesis.

Video thoracoscope was passed under vision, one bleb was identified which seemed to be leaking. A wedge resection of the was carried out, and subsequently, mechanical pleurodesis & talc pleurodesis of the whole pleural cavity ws carried out. Howerver, after we placed chest tube, we noticed significant air lead, Therefore, we reposition the videoscope and identified antoher bleb which as obviously leaking. This was resected using Endo-Gia staple with pericardial buttresses. there was another bleb in the rt lower lobe which was similarly excised. Confirmation done and chest tubes then placed.....

I am proposing codes 32655 & 32650. He thinks 32657 also.. I am not comfortable with coding 32657..My coding software does Not bundle any of these codes; I would really appreciate any insite on this...:eek:
 

lisigirl

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Hi Deb!

I agree, I would not bill both 32655 and 32657. I think you have to choose one or the other. Here's the thing, 32655 is defined as "VATS with excision-plication of bullae, including any pleural procedure" which means that you really shouldn't bill 32650 with this code. They do not bundle in CCI but I have had payers deny 32650 when billed with 32655.

Personally, I do not understand why this one VATS procedure includes all other pleural procedures. The RVUs on this code are not much different from the other VATS codes. So, the way I look at it, you could either bill 32655 alone or 32657 with 32650. The surgeon was removing blebs but he did it with wedge resections so I think you could argue that either code is appropriate. In the end, I think the reimbursement will end up being roughly the same.

I would probably bill 32655, but that's me :)

Lisi, CPC
 

dpumford

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Thanks!

Hi Lizi! Thanks sooooo much for replying :p I was hoping you would see and reply...once again your insite was very helpful....Take care and thanks again!!:)
 
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