32657 has been deleted for 2012. The VATS codes underwent many, many changes this year, by more completely separating the diagnostic and surgical VATS procedures, adding in lymphadenectomies, several new add-on codes, as well as indicating in revised text that you can't report a diagnostic VATS with a surgical VATS. If you can get your hands on a 2012 book, you can see that the changes are significant.
In 2012, you can bill a 32663 (lobectomy) with a diagnostic wedge resection +32668. (new add-on code).
If your surgery was done in 2011, I wouldn't bill the VATS wedge then the VATS lobectomy, even with resultant pathology. I would report the lobectomy with the -58, only if he opens. If not, bill the VATS lobectomy only.
The RAC hasn't really dug into physician surgical work that I'm aware of. We've had RAC requests primarily for our inpatient claims.
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