Wiki Thoracoscopy w/ lysis of adhesions

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broncsrox

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Don't know if this is the right forum. If not, sorry.

My general surgeon did a video-assisted thoracoscopy and in the body of the note indicates he did some lysis of adhesions but then had to stop when he came to an area with an inflammatory clot. He then placed a chest tube and terminated the procedure.

My research so far I'm thinking he did an pneumonolysis but I can't find a VATS code that I'm comfortable with. 32651 seems to be the closest but it doesn't seem based on my research that decortication and lysis of adhesions is the same thing. There is an open thoracotomy code for lysis of adhesions but no scope code.

Any thoughts would be greatly appreciated!
 
broncsrox said:
Don't know if this is the right forum. If not, sorry.

My general surgeon did a video-assisted thoracoscopy and in the body of the note indicates he did some lysis of adhesions but then had to stop when he came to an area with an inflammatory clot. He then placed a chest tube and terminated the procedure.

My research so far I'm thinking he did an pneumonolysis but I can't find a VATS code that I'm comfortable with. 32651 seems to be the closest but it doesn't seem based on my research that decortication and lysis of adhesions is the same thing. There is an open thoracotomy code for lysis of adhesions but no scope code.

Any thoughts would be greatly appreciated!
Click to expand...

What about 32650? Does he mention using talc? Decortication is not the same as lysis of adhesions. Decortication refers to stripping away the membranous tissues covering a portion (of the lung or all the lung 32652). In 32650 the physician instills a chemical solution into the chest or by abrading the surface of the lung and inside the chest cavity.
 
Thoracoscopy with lysis of adhesions

I'm having a similar problem with an op note. see note below:

ROCEDURES PERFORMED:
1. Multiple level intercostal nerve block.
2. Right thoracoscopic evacuation of loculated pleural effusion.
3. Pleurolysis of adhesions x30 minutes.


INDICATIONS: The patient is a 78-year-old lady who has had multiple repeated pneumonias within the past six months as well as a recent fall with multiple rib fractures. She has a chronic symptomatic right pleural effusion causing her some dyspnea as well as right-sided pain. She is taken today for evacuation.

FINDINGS: There was approximately a liter of pleural fluid which was serosanguineous in nature in her pleural space. There were multiple thin septations within the fluid throughout the pleural space. All these adhesions and septations were broken up. The lung was also adhesed to the chest wall, particularly around the apex and posteriorly. The periphery of the lung was freed up entirely.

An initial anteroinferior incision was made and the pleural space entered. The lung was visualized to be deflating as the thoracoscope was inserted and there were multiple septations which were thin and areas of serosanguineous pleural fluid. An additional port site was placed posterior to the tip of the scapula and through these two incisions. All the loculations in the pleural spaces were broken up. Pleural fluid was suctioned into traps and sent for cytology and micro. There were fairly significant lung adhesions around the apex and posteriorly. All these were taken down with Bovie cautery, totaling approximately 30 minutes of adhesiolysis. At the completion of this, the lung was entirely freed up. There were no palpable or visible lung masses at the periphery of the parenchyma. A 24 French HydroGlide chest tube was placed around the apex and the lung visualized to reinflate fully to the chest wall.

I'm leaning towards 32609 and maybe 22 for the adhesions.
 
With regards to the first post, I'm pretty sure you can only bill for a diagnostic VATS - 32601- because there is no code for a VATS pneumolysis except when performed with a total decortication. If significant effort/work was involved to take down the adhesions, I would add modifier -22 to 32601.

In the second example, I would probably bill with CPT 32653. There is no VATS code for draining a pleural effusion but when the effusion is loculated and needs to be broken up, I think I can justify billing with 32653, because technically, the efffusion is a foreign body - it shouldn't be there. I don't think I would bill separately for the lysis of adhesions.

just my thoughts :)

Lisi, CPC
eharkler@nmh.org
 
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