Hello, I am trying to determine when a diagnostic throracoscpy can be billed separately with modifier 59, when converted to open? The NCCI manual goes back and forth and I’m not sure when we can bill cpt 32601-59.

I have a provider who wants to bill CPT 32601-59 when converted to open once it it is realized the procedure cannot be done safely or for other reasons via vats, converts to open.

Any advise would be apprecaited, example –
Decision for Vats for decortication in ER day prior, on insertion of thoracoscope, it was noted that there were significant adhesions with purulence throughout the chest cavity and a trapped right lower lobe and right middle lobe. Based on this, it proved to be difficult to do a decortication through a VATS approach. It was decided to perform a posterolateral thoracotomy. A posterolateral thoracotomy was performed. The provider wants to bill the Vats in addition to the open procedure. Refers to chapter 5 NCCI " However, a diagnostic thoracoscopy is separately reportable with an open thoracotomy, thoracostomy, or mediastinal procedure if the findings of the diagnostic thoracoscopy lead to the decision to perform an open thoracotomy, thoracostomy, or mediastinal procedure, …with modifier 58".

The NCCI manual –

"14. A diagnostic thoracoscopy (CPT codes 32601, 32604, 32606) is not separately reportable with a surgical thoracoscopy on the ipsilateral side of the thorax.
A diagnostic thoracoscopy to assess the surgical field or extent of disease prior to an open thoracotomy, thoracostomy, or mediastinal procedure is not separately reportable. However, a diagnostic thoracoscopy is separately reportable with an open thoracotomy, thoracostomy, or mediastinal procedure if the findings of the diagnostic thoracoscopy lead to the decision to perform an open thoracotomy, thoracostomy, or mediastinal procedure. Modifier 58 may be reported to indicate that the diagnostic thoracoscopy and open procedure were staged or planned.
If a surgical thoracoscopy is converted to an open thoracotomy, thoracostomy, or mediastinal procedure, the surgical thoracoscopy is not separately reportable. Additionally a diagnostic thoracoscopy should not be reported in lieu of the surgical thoracoscopy with the open thoracotomy, thoracostomy, or mediastinal procedure. Neither a surgical thoracoscopy nor diagnostic thoracoscopy code should be reported with the open thoracotomy, thoracostomy, or mediastinal procedure code when a surgical thoracoscopy is converted to an open procedure.