bdmason
New
Need help coding a Thoracoabdominal Excision of a Pleural Tumor, any advice would be greatly appreciated on the following Opnote:
DESCRIPTION OF OPERATION:
The right chest and abdomen were prepped
and draped in a sterile fashion. We began with a limited right
thoracotomy incision. Upon entering into the pleural space, there was
a large tumor that occupied approximately half of the pleural space.
We felt that through this limited incision or even a posterolateral
thoracotomy that this tumor would not come through the incision and
that to remove it and evaluate it would be quite difficult. We,
therefore, elected to extend the incision to a right thoracoabdominal
incision. We divided the right costal margin, but we really did not
have to divide the diaphragm. After doing this, a chest retractor was
placed. We were able to much better evaluate this rather large tumor
in the right pleural space. It appeared to originate from the central
portion of the diaphragm. There were some mild adhesions which came
off quite easily from the right lower lobe. There were no other
adhesions present. Then, using electrocautery, we divided the
diaphragm with an approximate 1 to 2 cm margin circumferentially
around the tumor. There was really no significant major vessels
feeding this tumor from the diaphragm although there were some medium
size veins present. After completion of dividing the diaphragm
circumferentially around its base, the specimen was easily delivered
out of the chest and sent to pathology. There was some mild bleeding
from adhesions that were torn from the basilar segment of the right
lower lobe. These were controlled with an EndoGIA stapler stapling
across these. We then decided to patch the diaphragm which had an
approximate 5 to 6 cm defect with a Strattice patch. The Strattice
patch was cut to an appropriate size to cover the defect easily. We
then ran a 0 Prolene circumferentially around the patch to the
diaphragm. Upon completion of this, this really looked quite nice.
I know I can bill the 39561 for the Complex Repair of the Diaphragm with Strattice Patch, but I cannot find a code for a Thoracoabdominal approach for removing the tumor. Nor can I find a code for just a Thoracotomy with Removal of a Pleural Tumor. The pathology shows the tumor is a Solitary Fibrous Tumor of Pleura, so could that possibly be CPT 32150 Thoracotomy with removal of Intrapleural Foreign Body or Fibrin Deposit? Any thoughts would greatly be appreciated!
DESCRIPTION OF OPERATION:
The right chest and abdomen were prepped
and draped in a sterile fashion. We began with a limited right
thoracotomy incision. Upon entering into the pleural space, there was
a large tumor that occupied approximately half of the pleural space.
We felt that through this limited incision or even a posterolateral
thoracotomy that this tumor would not come through the incision and
that to remove it and evaluate it would be quite difficult. We,
therefore, elected to extend the incision to a right thoracoabdominal
incision. We divided the right costal margin, but we really did not
have to divide the diaphragm. After doing this, a chest retractor was
placed. We were able to much better evaluate this rather large tumor
in the right pleural space. It appeared to originate from the central
portion of the diaphragm. There were some mild adhesions which came
off quite easily from the right lower lobe. There were no other
adhesions present. Then, using electrocautery, we divided the
diaphragm with an approximate 1 to 2 cm margin circumferentially
around the tumor. There was really no significant major vessels
feeding this tumor from the diaphragm although there were some medium
size veins present. After completion of dividing the diaphragm
circumferentially around its base, the specimen was easily delivered
out of the chest and sent to pathology. There was some mild bleeding
from adhesions that were torn from the basilar segment of the right
lower lobe. These were controlled with an EndoGIA stapler stapling
across these. We then decided to patch the diaphragm which had an
approximate 5 to 6 cm defect with a Strattice patch. The Strattice
patch was cut to an appropriate size to cover the defect easily. We
then ran a 0 Prolene circumferentially around the patch to the
diaphragm. Upon completion of this, this really looked quite nice.
I know I can bill the 39561 for the Complex Repair of the Diaphragm with Strattice Patch, but I cannot find a code for a Thoracoabdominal approach for removing the tumor. Nor can I find a code for just a Thoracotomy with Removal of a Pleural Tumor. The pathology shows the tumor is a Solitary Fibrous Tumor of Pleura, so could that possibly be CPT 32150 Thoracotomy with removal of Intrapleural Foreign Body or Fibrin Deposit? Any thoughts would greatly be appreciated!