# Mediastinal exploration



## dpumford (Dec 17, 2008)

HI!

We had a patient that had a AVR done.  Pt was taken off bypass and chest was closed and sternum wired.. Then because of the chest tube output that was present the doctor determined that he needed to re-explore the chest.

Patient was re-steriley prepped and drapped. The skin incision was re-opened and wires pulled and removed.  After exploration which the source of bleeding could not be found chest was re-closed and re-wired.

Since the patient never left the OR room 35820-78 is not appropriate?? I was leaning toward procedure 20680.  

Any advise would be Greatly appreciated.  
Thank you!!


----------



## MLS2 (Dec 18, 2008)

I'm not sure, but I think I would do the 35820.  The re-exploration was done after the chest was closed and pt. was weaned from bypass.  I'm not sure that you would need the 78 mod. though since it wasn't a "return" to the OR.


----------



## jdrueppel (Dec 19, 2008)

OK -this is not my specialty so I'm just throwing this out there for discussion.

http://www.cms.hhs.gov/NationalCorrectCodInitEd/01_overview.asp#TopOfPage

Above is the NCCI Website address.  If you go to NCCI Policy Manual for Medicare Services and select Chapter 5 for services within CPT codes 30000-39999.  Towards the end it states that 20670/20680 is not separately billable.  It goes on to state that 35820 is not separately billable unless it is a "return to surgery".  So then, I'm down to the -22 modifier for unusual service but is it truly unusual when these services are inclusive per the above guidelines BUT I could justify with increased time and intensity due to chest closure x2.......  I know you guys deal with real world coding and I may be way off but thought I'd share the information for discussion.

Julie, CPC


----------



## lisammy (Jan 7, 2009)

Since the valve procedure was complete and the incision was closed, may I suggest 35820 with a 59 modifier, it was a seperate and distinct procedure, make sure to use a 998.11 as the diagnoisis.


----------



## MLS2 (Jan 7, 2009)

I was thinking to use the 35820 as well but I asked the CT surgeon that I bill for and he thinks that it should be included in the original procedure...maybe a 22 modifier, but he doesn't think a separate billing should occur.  So I'm kind of on the fence on this one.


----------



## krmichae (Jan 26, 2009)

I agree with the surgeon. The patient never left the OR so the 35820 is not applicable. This would be considered content of service in our practice.


----------



## cgorder (Feb 6, 2009)

I have had similiar situations like this and have inquired to the STS.  The advise was because this was during the same encounter and he never left the OR, I should bill with 22.  Had he left the OR then you could use the 35820-78.


----------

