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VATS - help

  1. #1
    Default VATS - help
    Medical Coding Books
    Hello. I am stumped on this one. I was looking at code 32656- ant then 38746 just not sitting right. Any help would be greatly appreciated - thank you . Here is the Op Note:

    Left video-assisted thoracoscopic surgery procedure, mediastinal lymph node biopsy.

    General double-lumen endotracheal anesthesia induced, bronchoscopy performed by Dr. The patient was placed in the right lateral decubitus position, and the left chest was prepped and draped. Eighthinterspace port was placed. Thoracoscope was introduced. A sixthinterspace incision was made. Mediastinal pleura were incised under thoracoscopic guidance. Two lymph nodes in the aortopulmonary window were identified, dissected, submitted to pathology. Frozen section waspositive for squamous cell carcinoma of the lung. Decision for lobectomy was deferred. A 28 chest tube was placed in the apex of the left thorax.
    The incision was closed in layers and the patient returned to the
    recovery room, having tolerated the procedure in stable condition

  2. Default
    I would just code 32606. The physician was doing a diagnostic procedure to determine what was wrong. VATS codes 32650-32665 are surgical codes used when the procedure is for treatment of a condition.
    CPT 38746 is for more extensive lymph node dissection (at the very least levels 4, 7 & 9 should be removed) and there has to be a primary procedure performed at the same time to bill this code anyway.

  3. #3
    AHHH I see what you are saying.. Thank you. Thoracic coding is so sticky for me and we just got 2 doc's on board. Do u have any sites or info that would be helpful to me i would greatly appreciate it

  4. Default
    I think the STS is extremely helpful. I go to their coding conference every year. Their website is

    I've been coding CT surgery for a few years so you can always email me with questions.

    Lisi, CPC

  5. #5
    Thank you so much I'm sure u will be hearing from me -

  6. Default CPT 32656 issue
    Hi Guys,

    Please help me on this issue.

    My doctor has billed CPT 32656 twice with in a month with the same Dx. As I know this procedure has 90 days global period. I"m confused how to correct this issue.

  7. #7
    Central Philadelphia chapter
    for the procedure done twice within a month, use a modifier. Look at Modifier 76 or 78.

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