LScoder2016
Networker
Hello, i am helping CVTS and was hoping to get some feedback as I have zero experience coding in this specialty.
Procedure(s) Performed:
Right VATS (32655)
RUL blebectomy (32655)
mechanical pleurodesis (32655)
Cryoanalgesia (64999)
Intercostal nerve block (32655) (i got an NCCI edit with 64420/64221 with 32655)( Code 64420 is a column 2 code for 32655. You may not override the edit. NCCI Edit Rule: )Anesthesia service included in surgical procedure
Chest tube placement (32655)
The patient was taken to the operating room, placed supine on the table, then general anesthesia with double lumen tube endotracheal intubation was carried out by the anesthesiologist. The patient was repositioned to the right side up decubitus position with the bed flexed down at the waist.
At this time IV ABX was given. He was then prepped and draped in the normal sterile fashion. The time out was performed. Then, an 1cm incision was made at the posterior axillary line, 9th intercostal space. After dissection, the right pleural space was entered, a trocar was inserted, followed by the VATS scope exploration was performed. At this time, cryoanalgesia was performed from 4th through 9th intercostal space which spent about 25 min, using AtriCure cryoprobe.
The intercostal nerve block was performed with 25% marcaine mixed with exparel for same intercostal spaces as well as for chest tube sites as well later After that, I found the blebs in the apex area of RUL lung. Then, .I used endostapler with staple guard to carry out the wedge resection of RUL. After that, I poured the NS into the pleural space and inflated the lungs and found no air leak at this time.
The lung was let down again. Then, I used scratch pad to make the entire chest wall rough for the mechanical pleurodesis. Then, 2 chest tubes were inserted, angled one to the base, straight one to the apex which all anchored to the skin with 0 silk sutures.
The wound was irrigated with antibiotic solution. The wound was closed in layers with Vicryl sutures. Then, a sterile dressing was applied.All the needles, sponges, and instruments were counted twice prior and after the procedure. The number was correct.
I got 32655 and 64999
Procedure(s) Performed:
Right VATS (32655)
RUL blebectomy (32655)
mechanical pleurodesis (32655)
Cryoanalgesia (64999)
Intercostal nerve block (32655) (i got an NCCI edit with 64420/64221 with 32655)( Code 64420 is a column 2 code for 32655. You may not override the edit. NCCI Edit Rule: )Anesthesia service included in surgical procedure
Chest tube placement (32655)
The patient was taken to the operating room, placed supine on the table, then general anesthesia with double lumen tube endotracheal intubation was carried out by the anesthesiologist. The patient was repositioned to the right side up decubitus position with the bed flexed down at the waist.
At this time IV ABX was given. He was then prepped and draped in the normal sterile fashion. The time out was performed. Then, an 1cm incision was made at the posterior axillary line, 9th intercostal space. After dissection, the right pleural space was entered, a trocar was inserted, followed by the VATS scope exploration was performed. At this time, cryoanalgesia was performed from 4th through 9th intercostal space which spent about 25 min, using AtriCure cryoprobe.
The intercostal nerve block was performed with 25% marcaine mixed with exparel for same intercostal spaces as well as for chest tube sites as well later After that, I found the blebs in the apex area of RUL lung. Then, .I used endostapler with staple guard to carry out the wedge resection of RUL. After that, I poured the NS into the pleural space and inflated the lungs and found no air leak at this time.
The lung was let down again. Then, I used scratch pad to make the entire chest wall rough for the mechanical pleurodesis. Then, 2 chest tubes were inserted, angled one to the base, straight one to the apex which all anchored to the skin with 0 silk sutures.
The wound was irrigated with antibiotic solution. The wound was closed in layers with Vicryl sutures. Then, a sterile dressing was applied.All the needles, sponges, and instruments were counted twice prior and after the procedure. The number was correct.
I got 32655 and 64999