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Bill a thoracoscopy when converted to thoracotomy?

  1. #1
    Question Bill a thoracoscopy when converted to thoracotomy?
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    The physician initially attempted to perform lung biopsy via thorascopic approach, but due to multiple lesions, it was not amenable to perform the VAT biopsy. Therefore a thoracotomy/wedge resection of the lung was performed. Would you bill for the attempted thorascopic biopsy with the code 32650-59, and then the wedge resection with code 32500? Or would you only bill the open procedure, code 32500?

  2. #2
    Charleston, WV
    I believe that when an endoscopic procedure is converted to open, you can only bill for the open procedure. To report the conversion from closed to open, add ICD-9 dx V64.41.

  3. #3
    Central Philadelphia chapter
    When a VATS turned open, I have been billing both and apply the modifier 59. These codes are not in cci edits / not in mutally ex, but I would say half are rejected as mutally exclusive- included in pmt for other procedure.
    I do like that dx V64.42. I will try that on my next claim and see if that helps get the claims paid by more carriers.

  4. Default Along the same lines, coding for VATS
    I have a surgeon who describes a VATS then says it included mini thoracotomy, which way should it be coded as a VATS or open procedure.
    Thanks for any suggestion.

  5. #5
    Charleston, WV
    According to the NCCI Policy Manual "If an initial surgical approach to a procedure fails and a second surgical approach is utilized at the same patient encounter, only the HCPCS/CPT code corresponding to the second surgical approach may be reported."

  6. #6
    Charleston, WV
    I have always been told that "mini-open" is open so I would bill for the open procedure.

  7. Default
    If a VATS biopsy leads to an open procedure (like a lobectomy) you can bill for both with the following codes;


    However, since this was VATs that didn't work, I would bill for the more extensive procedure alone, which was the open procedure.

    CT Coding companion states that if procedure is attempted thoracoscopically but is then converted, you can bill the open code with 32601-59 and dx 64.42I have found that not all plans will pay for the 32601 but some do, Medicare included.

    As for the mini-thoracotomy question, Dr. Nichols at the STS workshop stated that a mini thoractomy is still a thoractomy and should be coded as open. Something I didn't know until he said that....

    Lisi, CPC

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