Wiki VATS procedures

[justjoan]

I have a patient that we did a VATS wedge biopsy and sent it to pathology and when it came back as carcinoma at that point we decided to proceed and do a VATS lobectomy with lymph node dissection. I billed a 32663, 32657, and 38746. The biopsy and lobectomy are not bundled procedures. I feel that you should be able to bill both. Is this correct?

 

[kksmame1]

If the surgeon did a VAT lobectomy and a lymph node dissection you can not bill for the separate VAT wedge resection 32657 because the 32663 overrides the wedge procedure.

 

[Brooke8565]

If you check NCCI edits from CMS, you can bill the lobectomy with the wedge resection, as long as you put the appropriate modifier on 32657.

 

[lisigirl]

The modifier would not be appropriate in this case. You need to bill the more extensive procedure, which is 32663.

In addition, CPT 32657 is a surgical code used when the wedge resection is done to treat a condition. When it is done for the purpose of a biopsy, its really a diagnostic procedure and should be billed as 32602.

The Society of Thoracic Surgeons has recommended that if a VATS biopsy leads to an open lobectomy, you can bill the following: 32480, 32602-58. When a VATS biopsy leads to a VATS lobectomy though, you can only bill for the lobectomy.

Lisi, CPC
eharkler@nmh.org