# VATS with pleural effusion drainage



## ndriley10 (Oct 18, 2011)

Any thoughts on what code I should use on this surgery?  Iwas thinking 31645 and 32601 since the doctor didn't actually do a pleurodesis or decortication.

op note
ROCEDURES PERFORMED:
1.  Left video-assisted thoracoscopic surgery.
2.  Drainage of pleural effusion.
3.  Exploration of the pleural space.
4.  Placement of a large bore thoracostomy tube.

INTRAOPERATIVE FINDINGS:
1.  Murky pleural fluid consistent with early empyema.
2.  Some septations bluntly divided.
3.  Examination of the medial diaphragm near the esophagus revealed inflammation of epicardial fat but no evidence of anastomotic leak.

SPECIMENS:  Effusion for labs and culture.

DRAINS:  A 24-French HydroGlide left in place.

DESCRIPTION OF PROCEDURE:  The patient was brought to the operating room and placed in the supine position on the operating room table.  General endotracheal anesthesia was administered via double-lumen endotracheal tube, and the patient was repositioned in the right lateral decubitus position with left side up.  Appropriate pressure points were padded, appropriate lines and monitors were placed, and the patient's chest was prepped and draped in surgical sterile fashion for the above procedure.  A timeout was called and the patient's name and procedure were correctly identified.  Two Thoracoport incisions were made, one anterior to the scapula tip and inferior, one posterior to the scapula tip and superior.  The patient's left lung was deflated and the right lung was preferentially ventilated.  A large amount of murky pleural fluid, approximately 2500 mL, was suctioned out; this was sent for culture and cytology.  The camera was advanced in the pleural space and the pleural surfaces were all examined.  There were some septations between the lung and the chest wall.  These were broken up bluntly in order to prevent loculation.  The entirety of the pleural cavity was drained.  The lung itself was noted to be clear of inflammatory debris and did not require decortication.  Attention was turned to the medial and inferior area of the pleural space where a large bundle of pericardial fat was noted to be inflamed and densely adherent to the diaphragm.  There was no evidence of succuss or bile at this area and the decision was made not to try and remove or explore behind the epicardial fat.  A 24-French HydroGlide chest tube was then placed and brought out through a separate inferior stab incision and secured appropriately.  Multilevel intercostal nerve blocks were performed using 0.25% Marcaine.  The entirety of the pleural space was irrigated copiously and suctioned free.  Once this had been completed, the lung was deflated under direct vision.  It was noted to fill the pleural space without difficulty.  The thoracoscope was removed.  The incisions were then closed in layers using 2-0 Vicryl, 3-0 Vicryl, 4-0 Monocryl, and Dermabond was applied.  The patient was awoken from anesthesia and transferred to the recovery room in stable condition.  We will continue to monitor the results of his fluid studies and manage his chest tube postoperatively.


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## dvance4210 (Oct 20, 2011)

I think I would bill 32602 since he does state that this was sent for culture and cytology.  31645 is used if a bronch is done which was not noted.  I was going to suggest to bill the intercostal nerve block but CCI edits won't allow that either...so I guess just the 32602.

Dorinda


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