Comprehensive Guide to Lung Lobectomy Coding for Medical Coders

Key Terms:

1. Sleeve Lobectomy
2. VATS (Video Assisted Thoracic Surgery) Lobectomy
3. Lingulectomy

Indications / Associated Pathology:

1. Benign Tumor
2. Emphysema
3. Fungal Infection
4. Lung Abscess
5. Lung Cancer
6. Tuberculosis

Description:

• The right lung consists of three lobes: Upper, Middle, and Lower.
• The left lung has two lobes: Upper and Lower, as it shares space with the heart.
• The Upper Left Lobe and Lingula (a small segment at the base of the upper lobe) are two distinct body parts in ICD-10-PCS.
• Lingulectomy involves removal of the lingula, while lobectomy refers to the removal of an entire lung lobe.
• Lobectomy or lingulectomy can be performed using Open or Percutaneous Endoscopic approaches, with the majority done via VATS (Video-Assisted Thoracic Surgery), which is reported as Percutaneous Endoscopic.

Procedure Approaches:

1. Video-Assisted Thoracoscopic Surgery (VATS):
   • A small incision is made between ribs to access the thoracic cavity using a rigid or flexible fiberoptic endoscope.
   • The lung is partially collapsed to gain better visibility.
   • Instruments inserted through secondary sites clamp the blood vessels and bronchial tubes of the lobe or lingula to be removed.
   • The lobe or lingula is excised by dividing the vessels and bronchial tubes under direct visualization.
   • The remaining lung tissue is repaired with sutures or clips.
2. Open Approach:
   • An incision is made in the chest over the targeted lobe.
   • Rib spreaders are used to access the lung for resection.

Surgical Terminology:

• Resection: The removal of an entire body part (e.g., an entire lobe or the lingula).
• Excision: Removal of only a portion of a body part, which can be for therapeutic or diagnostic purposes.

Focus Points:

1. Resection vs. Excision:
   • Resection refers to the complete removal of a body part, such as a lung lobe or lingula.
   • Excision is the removal of only a part of the lung lobe or lingula.
   • Report resection for the removal of an entire lung lobe or lingula. If both lobes or lingula from the same lung are resected, report each as a separate resection.
2. Documentation Review:
   • Carefully review the operative report to confirm whether the procedure involved excision or resection.
   • Report additional lobes excised or resected with a separate body part value.
   • Removal of the lingula may affect the DRG based on the diagnosis.

Body System:

• Respiratory System

Root Operation Tables:

1. 0BB: Excision of Respiratory System (Cutting out or off, without replacement, a portion of a body part)
2. 0BT: Resection of Respiratory System (Cutting out or off, without replacement, all of a body part)

Body Parts:

• Upper Lung Lobe, Right
• Upper Lung Lobe, Left
• Middle Lung Lobe, Right
• Lung Lingula
• Lower Lung Lobe, Right
• Lower Lung Lobe, Left

Approaches:

1. Open
2. Percutaneous Endoscopic

Coding and Compliance:

• Accurately code the procedure by confirming whether an excision or resection was performed.
• For each additional lung lobe or lingula resected or excised, use a separate body part value.
• The resection of the lingula may impact the DRG based on the specific diagnosis.

Common Associated Procedures:

1. Bronchoplasty
2. Chest Wall Procedure
3. Excision of Bronchus
4. Lymph Node Excision or Resection
5. Lung Biopsy
6. Pleurodesis

Reimbursement:

• The MS-DRG assigned will depend on the principal diagnosis and other procedures performed. Below are examples of possible MS-DRGs:
  • Lobe Resection, Open or Thoracoscopic:
    • MS-DRG 957-959: Other Procedures for Multiple Significant Trauma
    • MS-DRG 163-165: Major Chest Procedure
    • MS-DRG 907-909: Other Procedure for Injuries
  • Specific Lung Lingula Resection, Open or Thoracoscopic (based on diagnosis):
    • MS-DRG 820-822: Lymphoma and Leukemia with Major Procedure
    • MS-DRG 826-828: Myeloproliferative Disorders or Poorly Differentiated Neoplasms with Major Procedure
    • MS-DRG 829-830: Myeloproliferative Disorders or Poorly Differentiated Neoplasms with Other O.R. Procedure
  • With Lobe Excision, Open or Thoracoscopic (with/without biopsy):
    • MS-DRG 820-822: Lymphoma and Leukemia with Major Procedure
    • MS-DRG 826-828: Myeloproliferative Disorders or Poorly Differentiated Neoplasms with Major Procedure
    • MS-DRG 163-165: Major Chest Procedure
  • With Lobe Excision, Thoracoscopic, Non-Diagnostic:
    • MS-DRG 957-959: Other Procedures for Multiple Significant Trauma
    • MS-DRG 907-909: Other Procedures for Injuries

Conclusion:

Medical coders must ensure precise documentation and coding of lung lobectomies, taking into account whether the procedure is a resection or excision, the number of lobes removed, and the surgical approach used. The associated DRG will depend on the diagnosis, the specific body part involved, and any additional procedures performed during the surgery.