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How do you code a pneumonectomy and lymphadenectomy with thoracoscopic approach?

Cathy Posted Sat 19th of November, 2011 15:14:39 PM

How do you code a pneumonectomy and lymphadenectomy with thoracoscopic approach?

SuperCoder Answered Sun 20th of November, 2011 03:58:53 AM

32657: Thoracoscopy, surgical; with wedge resection of lung, single or multiple
2nd part of the question:
If it is a Thoracic lymphadenectomy open approach,then
38746: Thoracic lymphadenectomy, regional, including mediastinal and peritracheal nodes (List separately in addition to code for primary procedure)

Plz confirm, if it is thoracospic lymphadenectomy or a thoracic lymphadenectomy.

Jennifer Answered Mon 21st of November, 2011 14:30:40 PM

38746 should only be used with an open procedure thoracotomy. I use 32657-22 and once the claim is processed send a letter as to why the -22 was used. The American College of Surgeons also confirmed this.

SuperCoder Answered Mon 21st of November, 2011 15:00:41 PM

I am new to this forum. It's really interesting to know all this. Yeah! I think Jen is absolutely right here. Patrick is also right in asking to confirm if it is a thoracoscopic or thoracic lymphadenectomy, because it is also possible that one is performed thoracoscopically and the other is performed 38746 is an add-on code for 32657.
But, Jen is right as per question's scenario that both done thoracoscopically, then we should code 32657-22, send a letter to justify modifier 22.
The modifier should justify that the expected level of additional reimbursement is atleast equivalent to 38746.

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