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Listed below are the ICD-9-CM diagnosis and
procedure codes as well as the CPT-4 procedure codes that
we think properly classify this episode of treatment. Please
note that modifiers, used only for physician billing purposes,
have not been assigned to the CPT-4 codes.
Procedures
Chamberlain procedure, mediastinal lymph node
biopsy, left chest tube insertion
Codes
and Rationale
The patient has a history of left apical lung mass with involvement
of the mediastinum. CAT scan, lymph node biopsy, and bronchoscopy
had been performed, but were inconclusive. The patient was
admitted to the hospital for surgery which included Chamberlain
procedure, mediastinal lymph node biopsy, and insertion of
left chest tube. Three ICD-9-CM codes are required to describe
this procedure.
The Chamberlain procedure, an anterior parasternal mediastinotomy,
is an approach used for inspection of mediastinal nodes, especially
nodes of the anterior mediastinal chain on the left into which
lymphatic drainage of the left upper lobe flows. The Chamberlain
procedure is coded to 34.1, Incision of mediastinum.
The lymph node biopsy is coded to 40.11, Biopsy of lymphatic
structure. Insertion of the left chest tube is coded to
34.04, Insertion of intercostal catheter for drainage.
In CPT-4, the Chamberlain procedure and mediastinal lymph
node biopsy are covered by a single code, 39010, Mediastinotomy
with exploration, drainage, removal of foreign body, or biopsy,
transthoracic approach, including either transthoracic or
median sternotomy. Insertion of the chest tube does not
require a CPT-4 code since it was done in conjunction with
the Chamberlain procedure and lymph node biopsy rather than
as a separate procedure.
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