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The procedure identified by CPT® Code 32491 is known as lung volume reduction surgery (LVRS). This surgical intervention is designed to remove damaged lung tissue, specifically targeting areas affected by emphysema, which may present as either bullous or non-bullous lesions. The term "lung volume reduction" refers to the process of excising portions of the lung to improve overall respiratory function by reducing hyperinflation and allowing the remaining healthy lung tissue to expand more effectively. In cases where LVRS is performed on both lungs, a sternal split approach is utilized, which involves making an incision in the center of the chest and splitting the sternum to access the lungs. Conversely, if the procedure is limited to one lung, a transthoracic approach is employed, involving an incision made between the ribs. During the surgery, the physician carefully removes the compromised lung tissue, which may account for up to 30% of the emphysematous lung, and subsequently sutures or staples the surrounding tissue together, a process referred to as plication. It is important to note that this procedure may also include any pleural procedures that are performed concurrently, as these are considered part of the overall surgical approach.
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The procedure coded as CPT® 32491 is indicated for patients suffering from severe emphysema, particularly when characterized by the presence of bullae, which are large air-filled spaces that develop in the lungs and can significantly impair respiratory function. The following conditions may warrant the performance of lung volume reduction surgery:
The surgical steps involved in CPT® 32491 are as follows:
Following the lung volume reduction surgery, patients typically require close monitoring in a recovery area to assess their respiratory status and manage any pain. Post-operative care may include the use of pain management strategies, respiratory therapy to aid in lung function recovery, and monitoring for potential complications such as infection or pneumothorax. Patients are usually advised on breathing exercises and may need to stay in the hospital for several days, depending on their recovery progress. Follow-up appointments are essential to evaluate the surgical outcomes and adjust any ongoing treatment plans as necessary.
| Short Descr | LUNG VOLUME REDUCTION | Medium Descr | RMVL LUNG OTH/THN PNUMEC RESXN-PLCTJ EMPHY LUNG | Long Descr | Removal of lung, other than pneumonectomy; with resection-plication of emphysematous lung(s) (bullous or non-bullous) for lung volume reduction, sternal split or transthoracic approach, includes any pleural procedure, when performed | Status Code | Restricted Coverage | 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 | 36 - Lobectomy or pneumonectomy |
This is a primary code that can be used with these additional add-on codes.
| 32674 | Add-on Code MPFS Status: Active Code APC C Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure) | 38746 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Thoracic lymphadenectomy by thoracotomy, mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure) |
| 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure 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) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2012-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Medium description changed. |
| 1997-01-01 | Added | First appearance in code book in 1997. |
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