# Thoracotomy w/ right middle & lower lobe lobectomy w bronchoscopy



## ksb0211 (Apr 7, 2011)

Thoughts on this?  We don't normally do a lot of lung stuff, so I was hoping that someone with a little more familiarity could provide their expertise?  :-D
__________________________________________________________________________
PROCEDURE/OPERATION
Right thoracotomy with right middle and lower lobe lobectomy with bronchoscopy.
DESCRIPTION OF PROCEDURE
The patient is taken to the operating room after the induction of adequate general anesthesia.  The patient was prepared for bronchoscopy.  The Olympus Fiberoptic bronchoscope was introduced via the Endo sterile tube. The carina was sharp. The right and left mainstem bronchi were within normal limits to the level of the segmental bronchi.  No endobronchial lesions were identified. The scope was removed.  The patient tolerated the procedure.
With this completed, the patient was turned in the left lateral position for a right posterolateral thoracotomy.  The skin was marked. The incision was made with a #15 blade. The dissection was begun down to the level of the fascia. The tissue was cleared off the fascia circumferentially in the depth of the wound.  The latissimus dorsi muscle was then retracted laterally and posteriorly.  The serratus anterior muscle was then retracted anteriorly.  The ribs were identified and counted the sixth interspace was chosen.  The Finochietto retractor and the toothier retractor were then placed.  The mass was palpable in the right lower lobe. The dissection was begun in the oblique fissure. The vasculature was well identified.  The inferior pulmonary ligament was divided with the LigaSure. The pleurae was scored with the electrocautery. Ultimately the inferior pulmonary vein was surrounded and divided after passing the TA-30 stapling device.  The pulmonary artery branches to the lower lobe were well controlled. These were triply tied and then divided.  The lateral and posterior aspect of the oblique fissure was then divided with the GIA stapling device.  The TA-30 was then passed above the level of the right middle lobe takeoff.  The right lower lobe was then passed off as specimen.  Dissection was then continued in the minor fissure. The vasculature to the middle lobe was controlled with 2-0 silk suture.  The venous flow to the middle lobe was well identified.  The fissure was completed with the GIA stapling device and the TA-30 with green staples.  This too was passed off as specimen.  An interlobar lymph node was passed off as specimen. The frozen section was negative. Multiple nodes were noted to be with the specimen itself.  The hilum was inspected and no obvious lymphadenopathy could be appreciated.  No further biopsies were taken.  The bronchus was inspected for air leak.  The lung was ______at 28 mmHg of pressure. The 36 angle and straight chest tubes were then placed. The ribs were reapproximated with #1 Vicryl suture. The muscles were allowed to return to its' previous position.  A 10 millimeters Jackson-Pratt drain was placed and then the subcutaneous tissue was reapproximated with running 0-Vicryl suture. Subcutaneous tissue was closed with
2-0 Vicryl suture. Clips were applied to the skin.  The estimated blood loss was 250 mL. The patient tolerated the procedure well and was taken to the recovery room in stable condition.


32482,32320-51???


----------



## daharden (Apr 8, 2011)

*thoracotomy*

You could use 32482 for the thoracotomy with 2 lobes removed.  You could bill for the bronch, 31622 with a modifier.  I do not know why you would bill for the 32320 for decortication and parietal pleurectomy when the lobes were removed.

Debbie


----------



## ksb0211 (Apr 8, 2011)

Thanks for your response.  I thought the same thing.  In my Ingenix CPT Expert book, underneath the description of 32482, it states "Code also (32320)".  Usually, it will state "code also XXXXX, as appropriate," but it did not this time so I was unsure.  That is one of the reasons I posted to this forum for some other input.

Thanks again.


----------

