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The procedure described by CPT® Code 32036 involves a thoracostomy with open flap drainage specifically for the treatment of empyema, which is an accumulation of pus in the pleural cavity. This surgical intervention is necessary when there is a need to drain an abscess located within the pleural space. The process begins with the physician making a small incision in the chest wall, strategically positioned over the rib that is situated above the empyema collection. To access the pleural space, a segment of the rib is excised, allowing entry into the cavity where the empyema resides. The physician then meticulously breaks down any loculated cavities within the pleural space, which may involve using a fingertip or suction tip to ensure thorough drainage. Following this, the empyema collection is aspirated, and the area is irrigated with an antibiotic solution to help prevent infection. A large bore chest tube is subsequently inserted through a separate incision to facilitate ongoing drainage. In the specific procedure denoted by CPT® Code 32036, an open, U-shaped skin flap is created over the site of the empyema to ensure effective drainage and to maintain the opening for continued fluid removal. This flap is designed to extend sufficiently to reach the pleural cavity without causing tension. Additionally, a section of rib is removed, and the tip of the flap is turned inward and sutured to the parietal pleura, which is the membrane lining the chest wall. This technique allows for open drainage of the empyema collection, promoting healing and recovery.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 32036 is indicated for the management of empyema, which is characterized by the presence of pus in the pleural space. This condition may arise due to various underlying causes, including pneumonia, lung abscess, or post-surgical complications. The primary indications for performing this procedure include:
The procedure for CPT® Code 32036 involves several critical steps to ensure effective drainage of the empyema. The steps are as follows:
After the completion of the procedure, patients typically require monitoring for any complications, such as infection or bleeding. The chest tube placed during the procedure will remain in situ to facilitate ongoing drainage of any residual fluid. Patients may also receive antibiotics to prevent infection. The expected recovery period can vary based on the individual patient's condition and the extent of the empyema. Follow-up care is essential to assess the effectiveness of the drainage and to determine if further interventions are necessary. Regular imaging studies may be performed to monitor the pleural space and ensure that the empyema is resolving appropriately.
| Short Descr | THORACOSTOMY W/FLAP DRAINAGE | Medium Descr | THORACOSTOMY OPEN FLAP DRAINAGE EMPYEMA | Long Descr | Thoracostomy; with open flap drainage for empyema | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 39 - Incision of pleura, thoracentesis, chest drainage |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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