Misty Dawn
Guru
Indication: biopsy-proven non-small cell lung cancer and CLL, SLL Syndrom. Referred for upper lobectomy with a growing nodule in the lung. Pet scan shows no hilar node involvement.
Operative findings: ...with no adhesions and tumor centrally located in the upper lobe. Lymph nodes appeared anthracotic and benign. A standard left upper lobectomy was performed via thoracoscopic approach. There were no complications.
A camera port was placed in the eigth interspace mid axillary line. Two operation ports were placed anteriorly over the fissure and over the hilum, and a posterior port was placed. We devided the inferior pulmonary ligament. A node at this area was removed. We mobilized the hilum anteriorly, identifying the upper and lower veins. AP windo nodes were removed. We circumscribed the upper lobe vien and divided this. Station 11 nodes were removed from around the lingular artery and bronchus. The lingular artery was identified and divided. The fissure was developed part way posteriorly. Around the bronchus, we dissected the pulmonary artery away from the bronchus and came around the upper lobe bronchus sparing, of course, the anteroapical branch. The bronchus ws divided with a bronchial load stapler. We then grabbed the bronchus on the specimen side and took adhesions and areolar tissue away from the arterial branches. The anterior apical bifurcation branch was divided. A posterior segmental branch and the second lingular branch were devided. The fissure ws completed. The speciman was placed in an Endo catch bag, brought out through one of the ports and sent to pathology for formal review. We irrigated with warm watr and had no air leak to 20 cm of water. Chest tube was placed through the camera port. The wound was anesthetized with ....chest xray was obtained. To recovery...
Can you code for node removal with a lobectomy? How node removals can you code for? Since it was sent to pathology can I use the diagnostic node removal code? or is all this just explaining the lobectomy?
VATS/lobectomy 32663
Intial node removal 32666 (in seprate lobe section)
Additional 32667 (in seprate lobe section) (how many x can you use additional?)
Diagnostic 32668 (portion sent to pathology??)
Thank you for any questions you can answer, I know I asked alot
Operative findings: ...with no adhesions and tumor centrally located in the upper lobe. Lymph nodes appeared anthracotic and benign. A standard left upper lobectomy was performed via thoracoscopic approach. There were no complications.
A camera port was placed in the eigth interspace mid axillary line. Two operation ports were placed anteriorly over the fissure and over the hilum, and a posterior port was placed. We devided the inferior pulmonary ligament. A node at this area was removed. We mobilized the hilum anteriorly, identifying the upper and lower veins. AP windo nodes were removed. We circumscribed the upper lobe vien and divided this. Station 11 nodes were removed from around the lingular artery and bronchus. The lingular artery was identified and divided. The fissure was developed part way posteriorly. Around the bronchus, we dissected the pulmonary artery away from the bronchus and came around the upper lobe bronchus sparing, of course, the anteroapical branch. The bronchus ws divided with a bronchial load stapler. We then grabbed the bronchus on the specimen side and took adhesions and areolar tissue away from the arterial branches. The anterior apical bifurcation branch was divided. A posterior segmental branch and the second lingular branch were devided. The fissure ws completed. The speciman was placed in an Endo catch bag, brought out through one of the ports and sent to pathology for formal review. We irrigated with warm watr and had no air leak to 20 cm of water. Chest tube was placed through the camera port. The wound was anesthetized with ....chest xray was obtained. To recovery...
Can you code for node removal with a lobectomy? How node removals can you code for? Since it was sent to pathology can I use the diagnostic node removal code? or is all this just explaining the lobectomy?
VATS/lobectomy 32663
Intial node removal 32666 (in seprate lobe section)
Additional 32667 (in seprate lobe section) (how many x can you use additional?)
Diagnostic 32668 (portion sent to pathology??)
Thank you for any questions you can answer, I know I asked alot