bennieyoung
Guru
32601 -59, The service has been denied because a column one and column two code from the NCCI Procedure to Procedure tables were reported on the same date of service and the CCI modifier submitted is not supported.
I coded …
Code 32220 (Decortication, pulmonary (separate procedure); total ) (column 1) has a CCI conflict with code 32601 (Thoracoscopy, diagnostic (separate procedure); lungs, pericardial sac, mediastinal or pleural space, without biopsy) (column 2). A modifier is allowed to override this relationship.
According to this I can use both codes together with the 59 modifier, which I did. I have been asked to provide information from the Op Note for the specifics of the 32601 procedure being medically necessary with 32220 and use of the CCI modifier so that it can be appealed.
In researching this, I’m coming to the realization I may have coded this incorrectly.
DESCRIPTION OF PROCEDURE: Patient was consented for surgery, brought to the operating room. Double-lumen endotracheal tube and Foley were placed. He was placed in a lateral decubitus position. He was prepped and draped sterile classical manner. I did not believe this would be treated with the scope, and therefore made a muscle sparing lateral thoracotomy in the 5th intercostal space. Upon entering the chest, there was a liter of serous fluid. Upon removing the fluid, there was a very dense adherent pleural peel which took some time to decorticate the lower lung. We avoided going anterior to avoid his previous left internal mammary artery, and freed up the lung as much as we could circumferentially. Upon opening the chest with opening the ribs, the diaphragm poor, which was extremely fibrosed up in the corner there, and was repaired with a pericardial patch with a continuous running 3-0 Prolene suture. Two chest tubes were placed. We also did intercostal cryoablation above and below and at the rib level, as well as Marcaine with epinephrine. The chest because of his large physical nature, and history of a heavy weightlifting, was closed with a stainless steel wire, the subcu tissue was closed with Vicryl, the skin was closed in a standard fashion.
If someone could look at this and offer any suggestions I would greatly appreciate it!
I coded …
Code 32220 (Decortication, pulmonary (separate procedure); total ) (column 1) has a CCI conflict with code 32601 (Thoracoscopy, diagnostic (separate procedure); lungs, pericardial sac, mediastinal or pleural space, without biopsy) (column 2). A modifier is allowed to override this relationship.
According to this I can use both codes together with the 59 modifier, which I did. I have been asked to provide information from the Op Note for the specifics of the 32601 procedure being medically necessary with 32220 and use of the CCI modifier so that it can be appealed.
In researching this, I’m coming to the realization I may have coded this incorrectly.
DESCRIPTION OF PROCEDURE: Patient was consented for surgery, brought to the operating room. Double-lumen endotracheal tube and Foley were placed. He was placed in a lateral decubitus position. He was prepped and draped sterile classical manner. I did not believe this would be treated with the scope, and therefore made a muscle sparing lateral thoracotomy in the 5th intercostal space. Upon entering the chest, there was a liter of serous fluid. Upon removing the fluid, there was a very dense adherent pleural peel which took some time to decorticate the lower lung. We avoided going anterior to avoid his previous left internal mammary artery, and freed up the lung as much as we could circumferentially. Upon opening the chest with opening the ribs, the diaphragm poor, which was extremely fibrosed up in the corner there, and was repaired with a pericardial patch with a continuous running 3-0 Prolene suture. Two chest tubes were placed. We also did intercostal cryoablation above and below and at the rib level, as well as Marcaine with epinephrine. The chest because of his large physical nature, and history of a heavy weightlifting, was closed with a stainless steel wire, the subcu tissue was closed with Vicryl, the skin was closed in a standard fashion.
If someone could look at this and offer any suggestions I would greatly appreciate it!