Wiki Vats diagnostic versus therapeutic

[atomic]

Is there anyone who can explain to me the difference between cpt 32607 and 32666. I have the following op note to code and am not sure which code to use:

Procedure: Right VATS with a right upper lobe, R middle lobe and R lower lobe wedge biopsy
Dx respiratory failure

Pt was positioned in right up thoracotomy position. A 10 mm working port was placed and we were able to enter the pleural space without difficulty. There did not appear to be any discrete masses, but there was an obvious cobblestoning appearance to his entire lung surface area. The fissures were clearly identified and there was no pleural -based obvious pathology. Using a separate port site, we were then able to introduce a 5mm camera and another site was then used to facilitate a Grabber to then isolate the apex of the R upper lobe. Multiple firings of a 10 mm and 45mm stapler were then used to wedge out a segment of the apex. Using similar techniques, a segment of the middle lobe as well as the lower lobe were identified and sent off to pathology. The lung was re- expanded and under direct supervision, the chest tube was placed.

I am fairly new at this specialty and am debating between cpt 32607 and 32666, 32667, 32667 -59

any help would be appreciated.

thanks

 

[dimmitta]

In 32607 the physician is taking biopsies with the primary intent to determine a diagnosis. 32607 is diagnostic and does not require attention to margins. In 32666 there is a defined mass and the purpose or intent is to provide a therapeutic treatment and would include attention to margins. Even if there is not a definitive diagnosis a procedure can still be a therapeutic procedure. These codes are based on the primary intent of the surgeon, or what they hope to accomplish with the procedure.

In this case, I would code this with 32607 since there is no mention of margins, there is no defined mass, and the physician actually calls it a biopsy (which is inherently diagnostic in nature).

Hope this helps!

 

[dvance4210]

I agree on the CPT 32607 for this particular case. if it was a nodule or mass you would use 32608. I make sure to advise my surgeon to include in the note that the margins are good, clear, etc...that way I can bill the 32666 without hesitation.

Also just a reminder that 32607 and 32608 have no global days, so it is appropriate to bill subsequent hospital visit while the patient is in the hospital and also for the post op visit.

D. Vance, CPC,CCVTC