Ask Dr. Z

Would you bill more than the 32666 for VATS wedge resection upper lobe with enbloc removal chest wall mass including deep tissue? Maybe a -22 modifier, or would this all be bundled under 32666? "Procedure: LEFT VATS wedge resection upper lobe with enbloc removal chest wall mass including deep tissue. An incision was made in the 7th intercostal space, and a camera was inserted. The mass was identified on the lateral chest wall with multiple adhesions of the lung overlying the mass. Most were loose adhesions. A working incision was made in the 4 ICS. The adhesions were taken down with use of electrocautery until the tumor appeared to be coming from the lung. Multiple firings of a stapler were used to perform a wedge resection of the mass with a negative margin. The mass was then dissected off the chest wall to obtain a wide margin to include soft tissue and intercostal muscle. A ICS neurovascular bundle was divided. The mass was then completely free and was placed within a glove and brought out through the working incision. No other pleural masses were seen."