# VATS for Chest Wall Resection



## jlbridges (Apr 15, 2011)

Would like opinion/s on resection of a chest wall resection.
Codes being considered:
19260 = open wo/rib involvement
---------would one use above code with mod 52 because tumor take with VAT 
OR 
32124 = VATS w/mediastinal tumor excision 
--------- even though the code states "medastinal area" the method of how tumor was removed fits the discription better.  


DESCRIPTION OF PROCEDURE: The patient was brought to the operating room. An attempt was made to place an epidural catheter; however, on 2 attempts, he had vasovagal reaction consisting of nausea, vomiting, bradycardia, and diaphoresis. He was allowed to recover in the operating room and then he was completely free of any symptomatology.  We desisted with the idea of placing an epidural. He was induced, and a double-lumen endotracheal tube was placed and then a left radial arterial line was positioned. Now with the patient turned from the supine to a left lateral decubitus posture, the chest was prepped and draped routinely. A small incision was made at about the sixth or seventh interspace anterior to the anterior axillary line. Through this incision, the chest was reviewed with a video-assisted thoracoscope. The mass was immediately encountered. Survey of the lungs and remaining chest wall were free of abnormalities. The mass was now excised using cautery to gently tease it from the chest wall and trying to get as much margin around any fat tissue as possible. Video documentation was taken. The tumor was allowed now up to drop into a specimen bag, and this was brought through one of our port sites. One of our 3 sites used for manipulation or removal was used for the chest tube, the other 2 were closed with layered Vicryl. The lung was allowed to reexpand. The patient appeared to tolerate this procedure satisfactorily.


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## lisigirl (Apr 21, 2011)

Personally, I would use 19260, no modifier. In CPT, this code is defined as "excision of chest wall tumor including ribs," it doesn't specifically indicate what approach needs to be used. 

The CT Coding Companion may describe this code as having an open incision but I would argue that those code explanations are just an example of how a procedure can be done. 
Due to the fact that this code is not defined as "excision of chest wall tumor including ribs, *open incision*" I would feel comfortable using it.

Other coders may disagree with me. If you would be more comfortable, add the -52 modifier (many times the payer doesn't even reduce the reimbursement with this modifier).  I wouldn't bill 32662 though.

Lisi, CPC
eharkler@nmh.org


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## Pam Brooks (Apr 22, 2011)

why wouldn't you use the VATS code for removal of mediastinal tumor, 32662?  Under the code description for the VATS, it states "the inside of the chest cavity is examined through a fiberoptic endoscope."  It doesn't necessarily have to be intrapleural.


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## lisigirl (May 12, 2011)

Because this is a tumor of the chest wall. The mediastinum is the area in the chest between the lungs. 

Lisi, CPC
eharkler@nmh.org


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## dadhich.girish (May 23, 2011)

VATS section is not defined to the greatest degree of specificity.  I would certainly use 32662.  No doubt.


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