Ask Dr. Z

"Midline sternotomy incision was made with removal of anterior mediastinal tissue starting from the diaphragm inferiorly, then dissected laterally as far as the phrenic neurovascular bundles , dissection continued over the innominate vein,, all venous attachments of the anterior mediastinal fat to the innominate vein were ligated, dissection then continued superiorly to the lateral horns of the thymic tissue. Of note the anterior mediastinal mass encroached upon the left phrenic neurovascular bundle as it crossed over the left pulmonary hilum. I did have to transect the thickened mediastinal fat at this point to preserve the phrenic nerve. Enlarged LN at stations 5 and 6 were removed."

We are thinking that this is a radical thymectomy and should be billed with 60522. But are unsure of how to code for the lymph node removal as this code is not a primary procedure for the add on code 38746.