Pulmonology Coding Alert

Question: My surgeon performed a partial lung removal (32480) and a thoracoscopy with lung wedge resection (32657). The carrier denied 32657 as a related service. Was the claim denied because we should not bill for a diagnostic procedure that turned into an open procedure?


Missouri Subscriber

Answer: Carriers consider diagnostic procedures a part of surgical procedures most of the time. In most cases, this rule applies to endoscopic services when the diagnostic portion identifies the site for therapeutic/ surgical intervention (that is, diagnostic thoracoscopy is included in surgical thoracoscopy). 

The payer may have denied your claim because they considered the two procedures related if the claim did not identify that the physician performed the procedures on two separate sites. 

If the surgeon performed a lobectomy in a different area of the wedge resection, you may want to provide the documentation and appeal the claim. When the surgeon ended the resection in order to perform the lobectomy (for the same site), CPT Assistant instructs you to report the open procedure on the first line of the claim form, followed by the thoracoscopic procedure with modifier -52 (Reduced services).

If you append modifier -52 to 32657 (Thoracoscopy, surgical; with wedge resection of lung, single or multiple), the modifier notifies the carrier that the surgeon did not perform the entire thoracoscopic procedure.

Tip: You should include documentation that indicates why the surgeon abandoned the thoracoscopic procedure. The documentation should also justify why the surgeon performed the open procedure, particularly when you submit the claim form to third-party payers.