Pulmonology Coding Alert

You can report thoracoscopic procedure(s) with ease if you follow a few simple and easy-to-remember guidelines. Here is a coding refresher to help master your thoracoscopy reporting.

Bundle Diagnostic Scopes With Surgical Scopes

If during the diagnostic thoracoscopy procedure the physician decides to perform a surgical thoracoscopy (32650-+32678), you should report the appropriate surgical thoracoscopy code only. You should not report the diagnostic thoracoscopy separately even though the observations found during this procedure prompted the surgeon to go in for a surgical thoracoscopy. "The most comprehensive procedure is reported in this case. NCCI also prevents reporting of the diagnostic throacoscopy (32601) with and surgical thoracoscopy code," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia.

Example: If you read that a 55-year-old male patient was assessed for chest pain and difficulty with breathing at your facility and your physician performed a diagnostic thoracoscopy to assess the problem and observed a foreign body lodged in the pleural space, you read further to confirm if another scope was used to remove the foreign body.

In this scenario, you have to only report 32653 (Thoracoscopy, surgical; with removal of intrapleural foreign body or fibrin deposit). You should not report 32601 (Thoracoscopy, diagnostic [separate procedure]; lungs, pericardial sac, mediastinal or pleural space, without biopsy) as this is bundled with 32653.

Note When to Report Diagnostic Scopes

If during the diagnostic thoracoscopy your surgeon decides to perform an open surgical procedure, use caution when reporting the diagnostic procedure separately. "The diagnostic procedure can be performed on the same day the open procedure is done, but NCCI bundles them, only allowing you to bypass the edit when the services are performed at separate sessions, or for separate reasons," says Pohlig.

Example: If in the above mentioned example, the physician finds that the foreign body is too large to be removed using surgical thoracoscopy and performs a thoracotomy to remove it, then you have to report the scenario with 32150 (Thoracotomy with removal of intrapleural foreign body or fibrin deposit). The diagnostic thoracoscopy is not reported with 32601 (Thoracoscopy, diagnostic [separate procedure]; lungs, pericardial sac, mediastinal or pleural space, without biopsy) unless the documentation clearly identifies a separate intent for each service.