deborahcook4040
Networker
64620 (destruction of intercostal nerve) is a CCI edit 1 with CPT 34280 (lobectomy), but can’t find any information re: under what circumstances is a modifier 59 appropriate? MD cryo-ablated 4 nerves. The cardiothoracic coding companions “average procedure” description does not include cryoablation of nerves at all with 32480. 64620 is billed per nerve , so if it’s bundled then how many nerves are “normal”? How do I know if it warrants a 22 modifier? Op report below.
PREOPERATIVE DIAGNOSIS: Non-small cell carcinoma of left upper lobe with emphysema.
POSTOPERATIVE DIAGNOSIS: Non-small cell carcinoma of left upper lobe with emphysema.
PROCEDURES PERFORMED: Left thoracotomy, left upper lobectomy, mediastinal lymph node dissection, and cryoablation of the intercostal nerves.
DESCRIPTION OF PROCEDURE: With the patient's left side up under general anesthesia, the chest was prepped and draped in the usual fashion. A left posterolateral thoracotomy was then performed. The left hemithorax Was entered. The patient had a large mass in the left upper lobe. He had a large amount of emphysematous changes, mainly in the left upper lobe and some in the left lower lobe. The arterial supply and venous drains were isolated to the left upper lobe, ligated with sill: suture, clipped and divided. Adhesions were taken down with sharp dissection. Several lymph nodes were also sent for permanent analysis, grossly they appeared normal. The inferior pulmonary ligament was divided. The bronchus of the left upper lobe was isolated. A T34.8 mm stapling device was placed across the bronchus. Prior to firing the staple gw, , the left lower lobe inflated appropriately. The staple gum was fired. The bronchus Baas bisected. The left upper lobe was removed. The margins were clear. Under high-pressure ventilation, the bronchus immersed in saline, no air leaks were noted. Chest cavity irrigated with warm saline solution. With the use of AtriCure cryoablation of the intercostal nerves, the 2 above and 2 below at this point were cryo-ablated. Following this, the chest cavity was irrigated with warm saline solution. Hemostasis was achieved. Straight right angle chest tube was placed, brought through separate stab
PREOPERATIVE DIAGNOSIS: Non-small cell carcinoma of left upper lobe with emphysema.
POSTOPERATIVE DIAGNOSIS: Non-small cell carcinoma of left upper lobe with emphysema.
PROCEDURES PERFORMED: Left thoracotomy, left upper lobectomy, mediastinal lymph node dissection, and cryoablation of the intercostal nerves.
DESCRIPTION OF PROCEDURE: With the patient's left side up under general anesthesia, the chest was prepped and draped in the usual fashion. A left posterolateral thoracotomy was then performed. The left hemithorax Was entered. The patient had a large mass in the left upper lobe. He had a large amount of emphysematous changes, mainly in the left upper lobe and some in the left lower lobe. The arterial supply and venous drains were isolated to the left upper lobe, ligated with sill: suture, clipped and divided. Adhesions were taken down with sharp dissection. Several lymph nodes were also sent for permanent analysis, grossly they appeared normal. The inferior pulmonary ligament was divided. The bronchus of the left upper lobe was isolated. A T34.8 mm stapling device was placed across the bronchus. Prior to firing the staple gw, , the left lower lobe inflated appropriately. The staple gum was fired. The bronchus Baas bisected. The left upper lobe was removed. The margins were clear. Under high-pressure ventilation, the bronchus immersed in saline, no air leaks were noted. Chest cavity irrigated with warm saline solution. With the use of AtriCure cryoablation of the intercostal nerves, the 2 above and 2 below at this point were cryo-ablated. Following this, the chest cavity was irrigated with warm saline solution. Hemostasis was achieved. Straight right angle chest tube was placed, brought through separate stab