lisamaddox
Guest
I have a surgeon that did a flex bronch, right VATS and wedge resection of lung nodule. I wanted to get some feedback on billing this procedure. I billed with 32657 and 31622. I was told by another billing service that I should have billed the 32650 as well, any thoughts on this? Thank you in advance for any advice on this one.
Here is OP note:
PROCEDURES PERFORMED: Flexible bronchoscopy, right video-assisted thoracic
surgery, wedge resection of lung nodule.
FINDINGS: Consistent with multiple pulmonary nodules. Preliminary frozen
specimens showed evidence of a mesenchymal type of tumor with multiple areas
of anaplasia consistent with malignancy.
CHEST TUBE LEFT IN PLACE: A 28-French, straight chest tube.
ESTIMATED BLOOD LOSS: Less than 5 mL
DISPOSITION: Stable.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and
was placed supine on the operating table. After the patient's identity was
confirmed, a timeout was performed, and the patient's right chest was marked
by me as the surgeon. The patient had his lines secured by the
anesthesiologist, and was then intubated with a double-lumen endotracheal
tube. At this time, the patient was then turned to the left lateral decubitus
position, and his right chest was prepped and draped in standard surgical
fashion. All his pressure points were padded accordingly. At this time, I
made an open cutdown approach over the patient's intercostal space #6 over the
posterior axillary line. I used an open cutdown approach, and I was able to
visualize the entire intercostal muscle layer. I was easily able to enter the
chest cavity safely and inserted my trocar into the patient's chest cavity. I
inserted the camera in, and I inserted all my other trocars under direct
visualization of the camera. At this time, I was able to see an index lesion
over the patient's right upper lobe, which was a subpleural pulmonary nodule.
I did a wedge excision of this nodule using Endo-GIA blue loaded staplers. I
put this in the Endobag and passed it off the field as a specimen for frozen
pathology. A chest tube was inserted over the posterior mediastinal recess,
and a chest tube was secured using an ethibon suture. All the incisions were
closed using Vicryl sutures after we insufflated the patient's lung to make
sure that all lobes insufflated accordingly. At the end of the case, all
sponge and needle counts were correct and accounted for. The pathologist gave a preliminary reading as a mesenchymal type of tumor with evidence of
anaplasia concerning for malignancy. We will wait for the permanent
specimens.
Here is OP note:
PROCEDURES PERFORMED: Flexible bronchoscopy, right video-assisted thoracic
surgery, wedge resection of lung nodule.
FINDINGS: Consistent with multiple pulmonary nodules. Preliminary frozen
specimens showed evidence of a mesenchymal type of tumor with multiple areas
of anaplasia consistent with malignancy.
CHEST TUBE LEFT IN PLACE: A 28-French, straight chest tube.
ESTIMATED BLOOD LOSS: Less than 5 mL
DISPOSITION: Stable.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and
was placed supine on the operating table. After the patient's identity was
confirmed, a timeout was performed, and the patient's right chest was marked
by me as the surgeon. The patient had his lines secured by the
anesthesiologist, and was then intubated with a double-lumen endotracheal
tube. At this time, the patient was then turned to the left lateral decubitus
position, and his right chest was prepped and draped in standard surgical
fashion. All his pressure points were padded accordingly. At this time, I
made an open cutdown approach over the patient's intercostal space #6 over the
posterior axillary line. I used an open cutdown approach, and I was able to
visualize the entire intercostal muscle layer. I was easily able to enter the
chest cavity safely and inserted my trocar into the patient's chest cavity. I
inserted the camera in, and I inserted all my other trocars under direct
visualization of the camera. At this time, I was able to see an index lesion
over the patient's right upper lobe, which was a subpleural pulmonary nodule.
I did a wedge excision of this nodule using Endo-GIA blue loaded staplers. I
put this in the Endobag and passed it off the field as a specimen for frozen
pathology. A chest tube was inserted over the posterior mediastinal recess,
and a chest tube was secured using an ethibon suture. All the incisions were
closed using Vicryl sutures after we insufflated the patient's lung to make
sure that all lobes insufflated accordingly. At the end of the case, all
sponge and needle counts were correct and accounted for. The pathologist gave a preliminary reading as a mesenchymal type of tumor with evidence of
anaplasia concerning for malignancy. We will wait for the permanent
specimens.