Wiki VATS help

[jtb57chevy]

I'm new to cardiothoracic and lung procedures make my head spin! Since nothing was removed but the fluid and no biopsies were done, 32601? Can I code for the bronch? And is there any code for the rib fracture stabilization?


PREOPERATIVE DIAGNOSIS: Right hemothorax, status post fall.

POSTOPERATIVE DIAGNOSIS: Right hemothorax, status post fall.

OPERATION: Flexible bronchoscopy, video assisted thoracic surgical drainage of right hemothorax with chest wall stabilization.


DESCRIPTION OF PROCEDURE: The patient was placed in the supine position on the operating room table. Antibiotics were administered according to said protocols and will be discontinued within 24 hours. After general endotracheal anesthesia with a double lumen endotracheal tube, flexible bronchoscopy was performed and revealed no evidence of endobronchial lesion or abnormality. The patient was placed in the lateral decubitus position with the right side up. The patient was prepped and draped in the normal sterile fashion. The patient was prepped and draped in a normal fashion. A 3 inch incision was made about the right chest wall and the 0-degree scope was passed. There was no evidence of intrapleural adhesions. There was 1500 ml of retained hemothorax which was completely drained. The lung that did not require decortication would expand to fill the space. Well loculated fluid collections were drained. There was placed rib fractures. One of the trocar sites was enlarged to expose the ribs and using heavy Vicryl sutures, they were passed through the ribs to restabilize the chest wall. The wounds were closed in anatomical layers of Vicryl and skin with Monocryl. Sterile dressings were applied. A 32 straight chest tube had been passed prior to this. The patient was awakened and extubated in the operating room and taken to the Intensive Care Unit in stable condition.

FINDINGS: 1500 ml of old blood, floating right rib.

SPECIMENS: None.

COMPLICATIONS: None.

TRNASFUSIONS: None.

CONDITION: Stable.

ESTIMATED BLOOD LOSS: 50 ml

 

[Pam Warren]

According to Society of Thoracic Surgeons, code 32601 for evacuation of hemothorax via VATS. There is a code for open treatment of rib fracture, 21805, which can be coded with the 32601. Since he mentions he opened the trocar opening wider, as in a mini-thoracotomy, I'm comfortable with coding the open procedure. I wouldn't code out the scout bronch.

 

[sharon.strong@lpnt.net]

Do you have a reference for why you would not code the bronch? I will need one if I advise that it can't be billed separately. Thanks!

 

[Pam Warren]

CCI edits clearly tell you not to code the scout bronch. Take a look at Chapter 3, I believe. Unless the bronch is done for therapeutic reasons, you'd bundle it into the VATS.