General Surgery Coding Alert

Question: The surgeon took a wedge biopsy of the lung and sent it to pathology. The biopsy was positive for malignancy, and the surgeon performed a lobectomy. Should I could for both the biopsy and lobectomy, or only for the lobectomy?

Maine Subscriber

Answer: In this case, you may report both the wedge biopsy (32500, Removal of lung, other than total pneumonectomy; wedge resection, single or multiple) and the subsequent lobectomy (32480, ... single lobe [lobectomy]).
 
Rules outlined in the narrative portion of the National Correct Coding Initiative (NCCI) state, "When, in the course of a procedure, a non-diagnostic biopsy is obtained and subsequently excision, removal, destruction or other elimination of the biopsied lesion is accomplished, a separate service cannot be reported for the biopsy procurement as this represents part of the removal." The same guidelines make clear, however, that "If the decision to perform a more comprehensive procedure is based on the biopsy result, the biopsy is diagnostic, and the biopsy service may be separately reported."
 
In other words, if the surgeon performed the wedge resection to determine malignancy (that is, the biopsy is diagnostic) and chooses to remove the entire lobe because of the biopsy results, you may charge separately for both the biopsy and lobectomy. If your payer will not recognize the biopsy in addition to the lobectomy, appeal the decision, citing the appropriate portion of NCCI in your defense.
 
You should, however, append modifier -59 (Distinct procedural service) to the lobectomy code (32480) to show that the lobectomy followed the biopsy in the operating room.