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thoracic coding

  1. #1
    Default thoracic coding
    Medical Coding Books
    I am very new to coding this and alot of codes are bundled and im not sure what is correct any help is appreciated:
    TITLE OF OPERATION: Left-sided thoracentesis followed by right chest thoracoscopy, pleural biopsy, and biopsy of right middle lobe.

    The patient was brought to the operating room and placed in the supine position. Following induction of general anesthesia the chest was prepped and draped using ChloraPrep. After infiltration of local anesthetic the chest was entered over the fifth rib in the lateral axillary line. Initially good flow of straw-colored fluid issued forth. The thoracentesis kit catheter was advanced into the pleural space and there was only intermittent flow from the catheter into the evacuated bottle. Total volume was approximately 50 mL. No complications were encountered. The catheter was removed and an occlusive dressing applied. The patient was then placed in the left lateral decubitus position with the right side up. All bony prominences were padded. The patient was secured to the table with both tape and safety strap after flexion and inflation of the bean bag. After executing rib blocks the space was entered through the seventh interspace in the mid axillary line. Thoracoport was inserted as was a suction. Approximately a 1.5 liters of bloody fluid issued forth. The pleural surfaces looked surprisingly clean as did the surface of the lung. Accordingly additional ports were placed anteriorly and using two-handed dissection pleural biopsies were taken. The pleura at the apex was then stripped away using gentle blunt dissection and the pleura which had been elevated was sent for pathology. As noted above, the lung surfaces appeared to be normal. Accordingly a representative wedge biopsy of the middle lobe was taken using three applications of the Endo GIA using the blue duet loads. The specimen was brought out through the initial Thoracoport incision through a small wound protector. Talc was then sprayed in the pleural surface under thoracoscopic control and a 24 French argyle chest tube was brought out through the most inferior of the 5 mm port sites which was in a more lateral position. This was positioned at the apex. The chest tube was secured to the chest wall using heavy silk. Wounds were closed with interrupted sutures of Vicryl for both deep and subcuticular skin closure. Occlusive dressings were applied. Chest tube was placed on suction. The patient was brought back to the Recovery Room in stable condition.

    thanks

  2. #2
    Location
    Jacksonville Florida Chapter
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    Default This this....
    Quote Originally Posted by herrera4 View Post
    I am very new to coding this and alot of codes are bundled and im not sure what is correct any help is appreciated:
    TITLE OF OPERATION: Left-sided thoracentesis followed by right chest thoracoscopy, pleural biopsy, and biopsy of right middle lobe.

    The patient was brought to the operating room and placed in the supine position. Following induction of general anesthesia the chest was prepped and draped using ChloraPrep. After infiltration of local anesthetic the chest was entered over the fifth rib in the lateral axillary line. Initially good flow of straw-colored fluid issued forth. The thoracentesis kit catheter was advanced into the pleural space and there was only intermittent flow from the catheter into the evacuated bottle. Total volume was approximately 50 mL. No complications were encountered. The catheter was removed and an occlusive dressing applied. The patient was then placed in the left lateral decubitus position with the right side up. All bony prominences were padded. The patient was secured to the table with both tape and safety strap after flexion and inflation of the bean bag. After executing rib blocks the space was entered through the seventh interspace in the mid axillary line. Thoracoport was inserted as was a suction. Approximately a 1.5 liters of bloody fluid issued forth. The pleural surfaces looked surprisingly clean as did the surface of the lung. Accordingly additional ports were placed anteriorly and using two-handed dissection pleural biopsies were taken. The pleura at the apex was then stripped away using gentle blunt dissection and the pleura which had been elevated was sent for pathology. As noted above, the lung surfaces appeared to be normal. Accordingly a representative wedge biopsy of the middle lobe was taken using three applications of the Endo GIA using the blue duet loads. The specimen was brought out through the initial Thoracoport incision through a small wound protector. Talc was then sprayed in the pleural surface under thoracoscopic control and a 24 French argyle chest tube was brought out through the most inferior of the 5 mm port sites which was in a more lateral position. This was positioned at the apex. The chest tube was secured to the chest wall using heavy silk. Wounds were closed with interrupted sutures of Vicryl for both deep and subcuticular skin closure. Occlusive dressings were applied. Chest tube was placed on suction. The patient was brought back to the Recovery Room in stable condition.

    thanks
    32421-LT for the left-sided thoracentesis.

    32602-RT for both biopsies since both were biopsies (lung and pleural) and not surgical removals as definied with codes 32650-32665.

    32551-RT-51 for the argyle chest tube. I noticed that this was included in the procedure, but was left off in the title of the operation. This is why you really need to read the procedure because sometimes the physician will either leave off the procedure in the title or they will have it in the title, but when you read the procedural notes, it's not there.

    That's all I saw. I hope my color coding doesn't confuse you, but instead shows you where I got the codes in accordance to what was in the record.
    John Meyer, CPC
    Heekin Clinic

  3. #3
    Default
    Thoracentesis with a catheter is 32422
    Thoracentesis with a needle is 32421


    (I would use 32422 for the thoracentesis)


    Christy Hembree, CPC
    Last edited by chembree; 11-28-2011 at 09:11 AM.

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