How To Use CPT Code 39220

CPT 39220 describes the resection of a mediastinal tumor through an open approach. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 39220?

CPT 39220 can be used to describe the excision or resection of a mediastinal tumor through an open approach. This code is used when a provider removes a benign or malignant tumor located in the mediastinum, which is the space between the lungs in the chest.

2. Official Description

The official description of CPT code 39220 is the excision of a mediastinal tumor through an open approach, except tumors of the heart and great vessels. This code should be used when a provider removes a tumor in the mediastinum, excluding tumors in specific structures such as the aorta, superior or inferior vena cava, caval trunk, pulmonary artery, or pulmonary vein. It is important to wait for the results of a pathological examination before coding to ensure accurate diagnosis, unless a previous biopsy has already confirmed malignancy.

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider positions the patient for a median sternotomy incision or in a left or right lateral position for thoracotomy, depending on the tumor’s location.
3. If a thoracotomy is performed, the provider incises the ribs and may use a rib spreader to access the target area. In a sternal approach, the provider incises the chest from the sternal notch to the xiphoid process and splits the sternal bone to access the mediastinum.
4. The provider carefully inspects the mediastinum for any signs of disease and removes any benign or malignant tumors found.
5. All bleeding is controlled by the provider.
6. Once the procedure is complete, the provider closes the incision, either by reapproximating the tissue between the ribs in layers for a thoracotomy approach or by wiring the sternum together and closing the soft tissue in layers over the bone for a median sternotomy incision.

4. Qualifying circumstances

CPT 39220 is used when a provider removes a mediastinal tumor through an open approach, excluding tumors of the heart and great vessels. The tumor can be either benign or malignant. The procedure is performed in the mediastinum, which is the space between the lungs in the chest. It is important to note that this code should not be used for tumors located in specific structures such as the aorta, superior or inferior vena cava, caval trunk, pulmonary artery, or pulmonary vein.

5. When to use CPT code 39220

CPT code 39220 should be used when a provider performs an excision or resection of a mediastinal tumor through an open approach, excluding tumors of the heart and great vessels. This code is appropriate when the tumor is located in the mediastinum and requires surgical removal. It is important to ensure that the tumor is not located in specific structures mentioned earlier, as different codes should be used for those cases.

6. Documentation requirements

To support a claim for CPT 39220, the provider must document the following information:

• Patient’s diagnosis and the need for tumor excision
• Details of the surgical approach used (median sternotomy or thoracotomy)
• Location and size of the tumor
• Pathological examination results, if available
• Procedure start and end times
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 39220, ensure that the procedure meets the criteria for an excision or resection of a mediastinal tumor through an open approach. It is important to note that this code should not be reported for tumors of the heart and great vessels. Additional tips for accurate billing include waiting for pathological examination results before coding and using an unlisted procedure code for excision of a mediastinal tumor via mediastinoscopy.

8. Historical information

CPT 39220 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone changes, including a code change on January 1, 2012, which updated the description to specify the excision of a mediastinal tumor. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A provider performs an open excision of a benign mediastinal tumor in a patient.
2. A thoracic surgeon resects a malignant mediastinal tumor through a median sternotomy incision.
3. A patient undergoes an open resection of a mediastinal tumor located in the anterior mediastinum.
4. A provider removes a benign mediastinal tumor through a thoracotomy approach.
5. A patient with a malignant mediastinal tumor undergoes an open excision procedure to remove the tumor.
6. A thoracic surgeon performs an open resection of a mediastinal tumor located in the posterior mediastinum.
7. A provider excises a benign mediastinal tumor through a median sternotomy incision.
8. A patient undergoes an open resection of a mediastinal tumor located in the middle mediastinum.
9. A thoracic surgeon removes a malignant mediastinal tumor through a thoracotomy approach.
10. A provider performs an open excision of a benign mediastinal tumor located in the superior mediastinum.