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Our coding consultant answers readers' questions.
Q. What is the correct code for a thoiracoscopic thymectomy?
-James Miller, MD, Fort Worth, TX
A. The appropriate CPT code is 32662-Thoracoscopy, surgical; with excision of mediastinal cyst, tumor, or mass. It includes the endoscopie approach for the procedure. It also specifically excludes these open thymectomy codes:1
* 60520-Thymectomy, partial or total; transcervical approach (separate procedure).
* 60521-Thymectomy, partial or total; sternal split or transthoracic approach, without radical mediastinal dissection (separate procedure).
* 60522-Hymectomy, partial or total; sternal split or transthoracic approach, with radical mediastinal dissection (separate procedure).
The only other option, depending on the operative report, is CPT code 32999-Unlisted procedure, lungs and pleura. Relate this to the most appropriate previously listed open code in terms of relative value units (RVUs).
Lymphedema after lumpectomy
Q. A patient had a lumpectomy with full axillary node dissection and returned with lymphedema of the upper extremity. May I bill for this management? When can I bill for problems beyond the global period and where would I find information regarding the specific global period for different procedures?
-Khoa Le, Corpus Christi, TX
A. You may bill separately for lymphedema management (CPT 97140) assuming you used code 19302, which has a 90-day global. There are no bundling edits regarding 19302 and the lymphedema massage and drainage code 97140. Some private carriers may have other issues, so you will need to check with the carrier. Lymphedema is a known complication of axillary excision. Medicare may want a modifier -59 applied to code 97140.
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