Wiki Help with Vats and Pleur-X cath

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ksrkelly7

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Lancaster, CA
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Hi all...any help would be appreciated. Is the only code 32601 because decortation wasn't done, or can I bill for the pleur-x cath placement as well? Please advise......


Indication for Surgery
Right Trapped Lung with Pleural Effusion

Preoperative Diagnosis
Right Trapped Lung with Pleural Effusion

Postoperative Diagnosis
Same

Operation
Right Thoracoscopy with Drainage of effusion and Placement of Pleur-X Catheter

Findings
Small Pleural effusion with Thick serofibrinous peal extremely adherent and causing trapped lung

Specimen(s)
Pleural fluid for culture

Complications
None

Technique
Pt intubated with single lumen ET tube . Bronchoscopy performed revealing normal endobronchial anatomy without mass or foreign body. Pt re-intubated with double lumen ET tube and placed in L lateral decubitus position. Three thoracoscopic ports were placed with some difficulty posteriorly due to adhesions between chest wall and lung. Lung freed completely from diaphragm Lung visualized and found to be trapped by a thick, shiny peal. Attempts to decorticate unsuccessful due to adherence to lung. Pleur-X catheter placed under direct visualization and placed to 20 cm H2O suction
Thoracoscopy ports closed in layers and sterile dressings applied Pt extubated in OR and transferred to PAR in stable condition. Pt tolerated procedure well.

Thanks for your help!!

Kelly CPC
 
I'm not sure this would work, but have you thought about billing (is it 32652?) with mod 53? The decortation was attempted, was unsuccessful due to extenuating circumstances, which was thoroughly documented in the notes, and IMO that would meet the criteria for the 53... It's not like they didn't try and credit should be given for that.
 
Don't get me wrong, I do see where you're coming from. But 32601 doesn't capture all that was done during the surgery. If there was no other way to bill for it, then 32601 would be correct. However, there IS another way to bill that describes the procedure more appropriately. When you have an alternative way of coding that credits the surgeon for the attempt and ensures proper reimbursement, that's the route you should take.

In your situation, the procedure was unsuccessful, meaning attempted, and it was unsuccessful for reasons beyond the surgeon's control - there was no other option except to discontinue. That situation is one of the reasons modifier 53 exists; along with threat to health and so on.

From an auditing perspective, I would say that 32601 does not sufficiently capture what the op note describes and would not be appropriate given that an alternative exists that would reflect all the components listed in the narrative. For accuracy and specificity, RVU, and reimbursement purposes, the intended procedure code should be used with a 53. Ultimately it's your decision though.
 
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