Orthopedic Spine Surgery Case: RTW Coding ConundrumsAs part of the new coding format for our newsletter, RT Welter is excited to offer you a new surgery coding series in which we want to help you! The 2nd week of every month we will highlight a complicated surgical case. This week we are highlighting a general surgery case. We want to hear from you! If you have a complicated surgery case and need help with coding, please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. RT Welter will not use any medical records submitted in which PHI is not removed and protected. Click Here To Submit Redacted Surgery Case Study

Preoperative Diagnosis:

  1.   Loculated empyema.

Postoperative Diagnosis:

  1. Loculated empyema, a trapped lung, a necrotic lung, with severe inflammatory rinds surrounding the entire right lung.

Procedure Performed:

  1. VATS converted to open thoracotomy.
  2. Partial lobectomy.
  3. Diaphragm.
  4. Decortication.
  5. Partial rib resection.

Complications: None.

Findings: Significantly trapped, necrotic lung with empyema, loculated fluid collections, and a significant inflammatory rind.

Indications: The patient is a 63-year-old female who has been in the hospital for 2 weeks with IR drainage of different fluid collections in the lung. Repeat CT scan shows continued loculated fluid collection, and white count continued to be elevated despite antibiotic therapy. Risks and benefits discussed with the patient, who agree with the treatment plan.

Correct CPT and ICD-10 Codes:

32320 / Modifier 22 / Dx: J86.9, J84.89, D72.829

32484 / Dx: J86.9, J84.89, D72.829

21600 / Dx: J86.9, J84.89, D72.829


32320: Decortication and parietal pleurectomy

Modifier 22 added due to, “Significant amount of adhesions to the point where they could not be

loosened”.  Multiple tries for VATS approach. Decision made to convert to open procedure.

32484: Removal of lung, other than pneumonectomy; single segment (segmentectomy)

21600: Excision of rib, partial

J86.9, Empyema (chest) (lung) (pleura)

J84.89: Interstitial pneumonitis

D72.829: Elevated leukocytes, unspecified

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