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Thread: VATS procedures

  1. #1

    Default VATS procedures

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    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?

  2. #2


    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.

  3. #3
    Join Date
    Apr 2007
    Tarrant County, Fort Worth


    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.

  4. #4


    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

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