General Surgery Coding Alert

Question: Our surgeon performed a VATS wedge resection biopsy and sent it to pathology, which came back during surgery as carcinoma. That's when the surgeon made the decision to proceed with a thoracoscopic segmentectomy. Can I bill for both the biopsy and the segmental resection?

Connecticut Subscriber

Answer: Yes, you should bill for both surgical thoracoscopy procedures in this case. The correct code forthe video-assisted thoracoscopic surgery (VATS) wedge resection is 32657 (Thoracoscopy, surgical; with wedge resection of lung, single or multiple). You should code the thoracoscopic segmentectomy as 32663 (... with lobectomy, total or segmental).

The Correct Coding Initiative (CCI) edits list 32663 as a "most extensive procedure" and bundles 32657 as the column 2 code. CCI lists a modifier indicator of "1" with the edit pair, however, meaning that you can override the edit when documentation for the case shows that the physician performed distinctly separate procedures. In this case, you can report both procedures because the surgeon performed two distinct services -- a diagnostic service to make the decision for a therapeutic service.

Do this: You should override a CCI edit pair using modifier 59 (Distinct procedural service). Append the modifier to the lesser (column 2) code: 32657.