jlbridges
New
Would like opinion/s on resection of a chest wall resection.
Codes being considered:
19260 = open wo/rib involvement
---------would one use above code with mod 52 because tumor take with VAT
OR
32124 = VATS w/mediastinal tumor excision
--------- even though the code states "medastinal area" the method of how tumor was removed fits the discription better.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room. An attempt was made to place an epidural catheter; however, on 2 attempts, he had vasovagal reaction consisting of nausea, vomiting, bradycardia, and diaphoresis. He was allowed to recover in the operating room and then he was completely free of any symptomatology. We desisted with the idea of placing an epidural. He was induced, and a double-lumen endotracheal tube was placed and then a left radial arterial line was positioned. Now with the patient turned from the supine to a left lateral decubitus posture, the chest was prepped and draped routinely. A small incision was made at about the sixth or seventh interspace anterior to the anterior axillary line. Through this incision, the chest was reviewed with a video-assisted thoracoscope. The mass was immediately encountered. Survey of the lungs and remaining chest wall were free of abnormalities. The mass was now excised using cautery to gently tease it from the chest wall and trying to get as much margin around any fat tissue as possible. Video documentation was taken. The tumor was allowed now up to drop into a specimen bag, and this was brought through one of our port sites. One of our 3 sites used for manipulation or removal was used for the chest tube, the other 2 were closed with layered Vicryl. The lung was allowed to reexpand. The patient appeared to tolerate this procedure satisfactorily.
Codes being considered:
19260 = open wo/rib involvement
---------would one use above code with mod 52 because tumor take with VAT
OR
32124 = VATS w/mediastinal tumor excision
--------- even though the code states "medastinal area" the method of how tumor was removed fits the discription better.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room. An attempt was made to place an epidural catheter; however, on 2 attempts, he had vasovagal reaction consisting of nausea, vomiting, bradycardia, and diaphoresis. He was allowed to recover in the operating room and then he was completely free of any symptomatology. We desisted with the idea of placing an epidural. He was induced, and a double-lumen endotracheal tube was placed and then a left radial arterial line was positioned. Now with the patient turned from the supine to a left lateral decubitus posture, the chest was prepped and draped routinely. A small incision was made at about the sixth or seventh interspace anterior to the anterior axillary line. Through this incision, the chest was reviewed with a video-assisted thoracoscope. The mass was immediately encountered. Survey of the lungs and remaining chest wall were free of abnormalities. The mass was now excised using cautery to gently tease it from the chest wall and trying to get as much margin around any fat tissue as possible. Video documentation was taken. The tumor was allowed now up to drop into a specimen bag, and this was brought through one of our port sites. One of our 3 sites used for manipulation or removal was used for the chest tube, the other 2 were closed with layered Vicryl. The lung was allowed to reexpand. The patient appeared to tolerate this procedure satisfactorily.
