Wiki requirements for billing 32674

[Janice Hannon]

I have a surgeon that did a VATS therapeutic wedge resection and removed lymph nodes from station 7. can this be billed with procedure code 32674 if not how would these services be billed?
Thanks,
Jhannon

 

[jvilla]

Have you looked at 32666 as well?

Depending if your surgeon's documentation is compliant, based on the information you provided as the primary and secondary procedures, you may report 32666 with 32674, these codes do not share an NCCI relationship.

Now for "billing" requirements, that depends on your payer (May want to reference appropriate MAC LCD). However, for coding 'direction,' the lay definition, as provided by Optum's EncoderPRO for Payers, states:
32666
"The physician performs a wedge resection of a lung mass or nodule through a rigid or flexible fiberoptic endoscope. The physician makes a small incision between two ribs and by blunt dissection and the use of a trocar enters the thoracic cavity. The endoscope is passed through the trocar and into the chest cavity. The lung is usually partially collapsed by instilling air into the chest through the trocar or the lung may be collapsed through a double lumen endotracheal tube inserted through the mouth into the trachea. The contents of the chest cavity are examined by direct visualization and/or by the use of a video camera. Still photographs may be taken as part of the procedure. Additional instruments may be inserted into the chest cavity through a second and/or third wound in the chest. Under direct visualization through the endoscope, the physician manipulates the instruments inserted through the secondary sites and clamps the blood vessels and bronchial tubes going to the sections of lung to be removed. With the clamps in place, the tissue is removed. Any cut portions of the lung tissue are repaired by suturing or clipping with surgical clips. At the conclusion of the procedure, the endoscope and the trocar(s) are removed. A chest tube for drainage and re-expansion of the lung is usually inserted through the wound used for the thoracoscopy"
32674
"..Under direct visualization through the endoscope, the physician manipulates the instruments inserted through the secondary sites and removes the lymph nodes near the lungs, around the heart, and behind the trachea.."

I hope this helps.