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Thoracoscopy with bleb resection, bilateral.

  1. Default Thoracoscopy with bleb resection, bilateral.
    Medical Coding Books
    Just wanted a little input with this one. I don't usually code these types of surgeries out, so I just wanted someone else's opinion and I don't want to miss anything. Thanks.

    Thoracoscopy with bleb resection, bilateral


    The patient was taken to the OR after induction of adequate general anesthesia, the patient was prepped with DuraPrep and draped sterilely. The patient was noted to be stable immediately after intubation on positive pressure. The patient was placed in a right lateral position and then prepped and draped. The skin incision was made in the mid axillary line approximately seventh interspace with a #15 blade. The OptiView port was passed without difficulty. I entered the chest cavity. The lung had been well deflated. The patient was noted to have evidence of ruptured blebs involving the lower lobe on the left side. The rest of the lung appeared to be remarkable for a few blebs, which appeared to be intact and asymptomatic. The 60 cm Endo stapling device was fired x3 to resect this portion of the lung. They leading edge of the left upper lobe was resected. The talc pleurodesis was then performed by spraying 5 g of aerosolized talc throughout the chest cavity. No air leak was detected at the end of the procedure. A 36 chest tube was placed and secured with 0 silk suture. The trocar sites were closed with 4-0 nylon vertical mattress sutures. A dry sterile dressing was applied.

    With this completed, the patient was turned in a left lateral position. The right chest was prepped and draped. The chest tubes were removed. The skin was incised inferiorly on the right side with a #15 blade. OptiView port was passed without difficulty. The chest was entered safely. A 5 and a 12 port were then again passed as per previous. The area in question at this time was medially in the right upper lobe. The blebs were resected. The patient tolerated this well. The talc pleurodesis was again performed, a 36 chest tube was placed and secured with 0 silk. The patient tolerated the procedure. The dry sterile dressing was applied. The estimated blood loss for both procedures, perhaps 200 mL. The patient was taken to the recovery room in guarded condition. Extubation will be attempted.

  2. #2
    Columbus, Ohio
    There is no real code for bleb resection (that I'm aware of) but it sounds like he did a VATS, left and right with talc pleuroldesis. The codes I would use is 32657-50 and 32650-50. I'm new at this so I welcome anyone else's opinion on this!


  3. Default
    We usually use 32655 with dx of 492.0 I would check with payer to determine if they want -50 or -59 with RT and LT
    Last edited by lisammy; 09-20-2011 at 11:42 AM.

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