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Help on procedure coding

  1. #1
    Default Help on procedure coding
    Exam Training Packages
    PROCEDURE: With the patient already prepped and draped, I
    extended the limited thoracotomy to a full lateral thoracotomy
    extending to the midline and extended for an upper sternotomy,
    creating a trap door sternotomy. The skin was incised with a
    scalpel. The pectoralis muscle was incised with electrocautery
    as was the intercostal space. The sternum was divided with the
    sternal saw. Now with adequate exposure to the chest, the
    pleural space was rapidly explored. There was really not
    significant bleeding, but this was due to the lack of any
    significant blood pressure. There is a readily visible
    penetrating wound at the medial apex of the pleural space in the
    region of the right subclavian vein and SVC junction. The
    pericardium was opened anteriorly using electrocautery and open
    cardiac massage was initiated. The heart was flaccid with asignificantly distended right atrium with no electrical activity,
    contractions or even fibrillation. Open cardiac massage was
    continued. Anesthesia dosed ACLS protocol drugs including
    epinephrine, bicarbonate and calcium. Direct intracardiac
    injection of epinephrine was attempted and during this time open
    cardiac massage continued. In spite of these efforts, no
    suitable cardiac rhythm was obtained. A total down time of
    almost 40 minutes was reported without a suitable blood pressure,
    and at that point, it was decided to terminate efforts as no
    suitable rhythm was able to be obtained. The patient was
    declared dead at this time.


    Ok, I am struggling with this one. My inclination is to only code 32160 and I am wavering on using a 52 modifier. The thoracotomy was started by someone else and it was not closed. I don't feel a 62 is appropriate since it appears the other doctor walked away when the CVT surgeon got there. In fact he didn't even document his part of the surgery at all (another issue in and of itself).

    I have 2 other coders giving 2 different code sets from what I come up with. Opinions greatly appreciated. Below are the 3 options on the table so far. The first one is way off, not sure what note she was reading but it is still out there.

    Code set 1- 35761-62, 92950-62-59

    Code set 2- 33020-62, 321600-62

    Code set 3- 32160 possibly with a 52

    Thanks

    Laura, CPC, CEMC

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default What about a -54 modifier?
    Okay .. this is NOT my area of expertise, and this may be way out there ...

    What about 32160 -54 ... clearly there will be no postoperative care for this patient.

    I am curious about why the first surgeon didn't document his/her work of opening the chest. This code DOES accept the -62 modifier.

    Oh, well ... hope that doesn't muddy the waters too much.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Smile help on procedure code
    Quote Originally Posted by katmryn78 View Post
    PROCEDURE: With the patient already prepped and draped, I
    extended the limited thoracotomy to a full lateral thoracotomy
    extending to the midline and extended for an upper sternotomy,
    creating a trap door sternotomy. The skin was incised with a
    scalpel. The pectoralis muscle was incised with electrocautery
    as was the intercostal space. The sternum was divided with the
    sternal saw. Now with adequate exposure to the chest, the
    pleural space was rapidly explored. There was really not
    significant bleeding, but this was due to the lack of any
    significant blood pressure. There is a readily visible
    penetrating wound at the medial apex of the pleural space in the
    region of the right subclavian vein and SVC junction. The
    pericardium was opened anteriorly using electrocautery and open
    cardiac massage was initiated. The heart was flaccid with asignificantly distended right atrium with no electrical activity,
    contractions or even fibrillation. Open cardiac massage was
    continued. Anesthesia dosed ACLS protocol drugs including
    epinephrine, bicarbonate and calcium. Direct intracardiac
    injection of epinephrine was attempted and during this time open
    cardiac massage continued. In spite of these efforts, no
    suitable cardiac rhythm was obtained. A total down time of
    almost 40 minutes was reported without a suitable blood pressure,
    and at that point, it was decided to terminate efforts as no
    suitable rhythm was able to be obtained. The patient was
    declared dead at this time.


    Ok, I am struggling with this one. My inclination is to only code 32160 and I am wavering on using a 52 modifier. The thoracotomy was started by someone else and it was not closed. I don't feel a 62 is appropriate since it appears the other doctor walked away when the CVT surgeon got there. In fact he didn't even document his part of the surgery at all (another issue in and of itself).

    I have 2 other coders giving 2 different code sets from what I come up with. Opinions greatly appreciated. Below are the 3 options on the table so far. The first one is way off, not sure what note she was reading but it is still out there.

    Code set 1- 35761-62, 92950-62-59

    Code set 2- 33020-62, 321600-62

    Code set 3- 32160 possibly with a 52

    Thanks

    Laura, CPC, CEMC
    My 2 cents I lean 3 with not mod. Clearly had the patient survived post op care would have been given. It was an emergent case which would qualify for a 22. So then why put a 52? My reasoning. I disagree with #1 open hear massage was documented I agree the ACLS protocol was documented but he/she arrived for the cardiac massage and exploration.
    #2 I diagree with the 33020 due to the fact one must get through the pericardium to get to the heart,
    no on 62 providing you have called the other MD's office and they are not billing with a 62.
    I beleive you mention that the other physician has not billed or dictated. I agree the chest was opened and no pre and post op care given.
    anyway my 2 cents.
    Have a great day
    Linda K

  4. #4
    Default
    Interesting thoughts, thanks for the replies.

    I'm thinking the 52 because he didn't open or close. 54 is a good point as well.

    I don't know how I could do a 22 though, yes it was emergent but he was only in the OR 15 minutes and like I stated above didn't do all the included parts of the procedure. I know it says total down time 40 minutes but the in and out times for the surgeon I am dealing with (this is his note) were 21:55 to 22:10.

    Thanks

    Laura, CPC, CEMC

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