Wiki VATS with lung biopsy

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lindacoder

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After adequate anesthesia was obtained the patient was placed in the left lateral decubitus position. The right chest was prepped with chlorhexidine and draped in the normal fashion. An incision was made over approximately the seventh intercostal interspace in the anterior axillary line. The subcu tissue was dissected down. Dissection was carried over the top of the rib. The right lung was allowed to desufflate and then the pleural space entered. Under direct vision with the thorascope, two additional thoracoscopic ports superior and posterior to this were placed under direct vision. The lung was mildly inflamed in appearance. A portionof the lower lobe was grasped and elevated.With successful firings f an Echelon stapler, a biopsy was taken. The specimen was removed. A portion was sent for culture and the remainder sent for final pathology. Care was taken to make sure were were a good 2 cm into the parenchym of the lung. Hemostas was assurred. The remainder of the thoracoscopic exploratin was unremarkable. Chest tube was placed through one of the thoracorts. Lung was allowed to desufflate and the thoracoports were removed.


Looking at 32650 & 32095 - am I anywhere close???
 
Vats

According to the documentation your codes do fit the description of the procedures. I have read it over and over. I am not perfect, I hope to see more comment on this case.

thank you.
 
VATS thoracoscopy

I think the code 32602 would be correct. The approach is definitely laparoscopic and a biopsy was done. Nowhere do I see a pleurodesis. The chest tube is bundled into 32602
 
For this case, bill 32602 only. There is no documentation of a pleurodesis (usually they'll mention talc or even the details of the procedure, which is not usually done unless the patient has pleural effusion), nor would you bill the thoracotomy. The 32602 is a VATS procedure, and always include the incisions for the camera ports. Thoracotomy is an open procedure. VATS are scoped (laparascopic) procedures. Chest tube placement is integral to the main procedure.
Two good references are Ingenix's Coding Companion, and also check out the Society of Thoracic Surgeons.

Hope this helps. Pam
 
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