Wiki Help with Thoracoscopy and aortopulmonary window lymph nodes

[Patricia Donegan]

Help....pt had a VATS with bx of aortopulmonary window lymph nodes. Surgeon
chose code 32662, Surgical thoracoscopy with excision of mediastinal cyst, tumor or mass. I do not feel this is correct, but should rather use a diagnostic thoracoscopy code,
like 32602 .....should I also use 38746 for the lymphadenectomy? He stated...."no masses or nodules in parietal pleura, mediastinaal and deaphragmatic surgaces were freee of abnormal findings. ...through the port incision, the upper and lower lobes were rotated inferiorly and anteriorly exposing the aortic arch through the posterrior working port incision. The instrument was inserted and the parietal pleura inferiror to the aortic arch was opened and lymph nodes in the aortopulmonary window station were seen. ....multiple bioopsies of taken of the aortopulmonary window lymph nodes were taken. :
Anyone have any thoughts????
thanks

 

[lisigirl]

I agree, it would be a diagnostic VATS code, not the surgical one the physician chose. I would use 32606 because this was a biopsy of the mediastinum, not the lung or pleura.

CPT 38746 is not appropriate because that is for a radical lymphadenectomy. To bill this code, at the very least, all nodes from level 4, 7 and 9 (on the right) or 5,6,7 and 9 (on the left) should be removed.

hope that helps.

Lisi, CPC
eharkler@nmh.org