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Thoracic Surgery

Maria Posted Mon 21st of June, 2010 14:45:29 PM

I hope someone can clarify the following. A thoracic surgeon performs a video assisted thoracoscopy and removes a wedge from the upper lobe of the right lung. The wedge is sent for pathology and comes back positive for carcinoma. He then proceeds to make one of the VATS incisions longer and does a completion lobectomy. He would like to bill the following '32480' for the lobectomy via a thoracotomy (he made one of the VATS incisions longer) and '32657' for a surgical VATS wedge resection. Would this be the proper way to code this scenario. Any assistance and/or clarification would be very much appreciated.

SuperCoder Answered Tue 22nd of June, 2010 06:26:48 AM

Per CPT Assistant (Fall 1994) when an open procedure such as a lobectomy via thoracotomy is done following a thoracoscopic diagnostic procedure, the correct way to bill is to report the open procedure in the first line followed by the thoracoscopic procedure with a modifier 52. Though the codes are not bundled, Medicare may not pay for the thoracoscopic diagnostic procedure and some payers may follow Medicare guideline in this matter. So I would suggest to clarify with your payer or try reporting as suggested by CPT Asst.

SuperCoder Answered Tue 22nd of June, 2010 10:48:34 AM

In my opinion, modifier 52 is not necessary in this case, because the doctor has already removed the wedge from upper lobe. He did not abort the Px due to some suddenly-arising situation. Therefore, as Ash said, 32480 should be billed in the 1st line, and 32657 in the 2nd line (w/o modifier 52). Also, a secondary Dx code V64.42 could be coded to show the shift from endoscopic to open Px.

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