surgerycoder
Contributor
I don't normally code Cardio Thoracic cases, so I'm not familiar with the rules. I have searched but am still confused. Can you bill for both a biopsy of a lung infiltrate and a biopsy of a lung nodule if they are on the same side, but different lobes?
Preoperative Diagnosis: Bilateral pulmonary infiltrates.
Postoperative Diagnoses: Bilateral pulmonary infiltrates including also mediastinal adenopathy
Procedures: 1. Mediastinoscopy with lymph node staging, rule out malignancy. 2. Right thoracoscopic lung biopsy infiltrates, right upper lobe and right middle lobe.
Specimens: From mediastinoscopy, level lymph node submitted for frozen section returning concerning for granulomatous changes. Samples sent for culture and for permanent. From the right thoracoscopy, abnormal infiltrates, right upper lobe, right lower lobe, right middle lobe. Again, right upper lobe and right middle lobe submitted for permanent and culture. Initial frozen section concerning for granulomatous inflammation.
Description: (left out beginning incision/thoracoscopy entry details and Mediastinoscopy part 39402)
The right lower lobe with the exception of a very small area near the major fissure appeared normal. The right middle lobe appeared normal with the exception of the most posterior aspect of the inferior and posterior margin of the upper lobe,however, had a very inflamed and scarred appearance, also created a very thickened lung parenchyma. We introduced a thoracoscopic Tri-Staple, however, even with this larger size, we could not encompass the entirety of the abnormal area in the posterior right upper lobe. Therefore, a smaller corner was selected and biopsy was performed using 2 firings of the other suture Tri-Staple. The specimen was submitted for frozen section and permanent section as well as for culture. Next, there was an abnormal area long the posterior aspect of the right middle lobe. This was also removed by biopsy using a 60mm purple Tri-Staple. Finally, an area in the anterior middle lobe nodular area was also identified. This was biopsied in a similar fashion. Again, specimens were submitted for permanent and for culture.
Path: Benign lung parenchyma with non-caseating granulomatous inflammation
CPT
39402
32608 59
32607 59
Thank you,
Preoperative Diagnosis: Bilateral pulmonary infiltrates.
Postoperative Diagnoses: Bilateral pulmonary infiltrates including also mediastinal adenopathy
Procedures: 1. Mediastinoscopy with lymph node staging, rule out malignancy. 2. Right thoracoscopic lung biopsy infiltrates, right upper lobe and right middle lobe.
Specimens: From mediastinoscopy, level lymph node submitted for frozen section returning concerning for granulomatous changes. Samples sent for culture and for permanent. From the right thoracoscopy, abnormal infiltrates, right upper lobe, right lower lobe, right middle lobe. Again, right upper lobe and right middle lobe submitted for permanent and culture. Initial frozen section concerning for granulomatous inflammation.
Description: (left out beginning incision/thoracoscopy entry details and Mediastinoscopy part 39402)
The right lower lobe with the exception of a very small area near the major fissure appeared normal. The right middle lobe appeared normal with the exception of the most posterior aspect of the inferior and posterior margin of the upper lobe,however, had a very inflamed and scarred appearance, also created a very thickened lung parenchyma. We introduced a thoracoscopic Tri-Staple, however, even with this larger size, we could not encompass the entirety of the abnormal area in the posterior right upper lobe. Therefore, a smaller corner was selected and biopsy was performed using 2 firings of the other suture Tri-Staple. The specimen was submitted for frozen section and permanent section as well as for culture. Next, there was an abnormal area long the posterior aspect of the right middle lobe. This was also removed by biopsy using a 60mm purple Tri-Staple. Finally, an area in the anterior middle lobe nodular area was also identified. This was biopsied in a similar fashion. Again, specimens were submitted for permanent and for culture.
Path: Benign lung parenchyma with non-caseating granulomatous inflammation
CPT
39402
32608 59
32607 59
Thank you,