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The procedure described by CPT® Code 32503 involves the surgical resection of a tumor located at the apex of the lung, commonly referred to as a Pancoast tumor. These tumors are characterized by their tendency to invade surrounding structures, including the chest wall, lymphatic vessels, and various neural components such as the brachial plexus and intercostal nerves. The surgical approach typically requires a posterolateral thoracotomy incision, which is strategically made below the shoulder blade and extends around the rib curvature to the front of the chest. This incision allows for adequate exposure of the lung apex and the surrounding anatomical structures. During the procedure, the surgeon may need to remove portions of the first, second, and sometimes third ribs to access the tumor effectively. If the tumor has infiltrated neurological structures, dissection and severing of specific nerve roots may be necessary. In cases where the tumor extends into the intervertebral foramen, additional procedures such as hemilaminectomy or vertebral body resection may be performed. The ultimate goal of the surgery is to mobilize and completely resect the apical lung mass, which may involve the removal of the apical lung segment, upper lobe, or in rare instances, the entire lung along with the affected chest wall. Following the resection, chest tubes are typically placed to facilitate drainage, and the incision is closed with sutures. It is important to note that if chest wall reconstruction is required after the tumor resection, a different CPT® code, 32504, should be reported.
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The procedure is indicated for the surgical removal of apical lung tumors, particularly Pancoast tumors, which are known for their aggressive nature and potential to invade adjacent structures. The following conditions may warrant this surgical intervention:
The surgical procedure for CPT® Code 32503 involves several critical steps to ensure the complete resection of the apical lung tumor:
Post-procedure care involves monitoring the patient for complications such as bleeding, infection, or respiratory issues. The placement of chest tubes will require careful management to ensure proper drainage and prevent pneumothorax. Patients may experience pain at the incision site and in the chest wall, which can be managed with appropriate analgesics. Recovery will vary based on the extent of the surgery and the patient's overall health, but follow-up appointments will be necessary to assess healing and any further treatment needs. If chest wall reconstruction is performed following the tumor resection, it is important to report the appropriate CPT® code, 32504.
| Short Descr | RESECT APICAL LUNG TUMOR | Medium Descr | RESCJ APICAL LUNG TUMOR W/O CHEST WALL RCNSTJ | Long Descr | Resection of apical lung tumor (eg, Pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; without chest wall reconstruction(s) | 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) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | 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) | P1F - Major procedure - explor/decompr/excis disc | MUE | 1 | CCS Clinical Classification | 42 - Other OR therapeutic procedures on respiratory system |
This is a primary code that can be used with these additional add-on codes.
| 32507 | Addon Code MPFS Status: Active Code APC C Thoracotomy; with diagnostic wedge resection followed by anatomic lung resection (List separately in addition to code for primary procedure) | 32668 | Addon Code MPFS Status: Active Code APC C Thoracoscopy, surgical; with diagnostic wedge resection followed by anatomic lung resection (List separately in addition to code for primary procedure) | 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) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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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| 2013-01-01 | Changed | Guideline information changed. |
| 2006-01-01 | Added | Code added |
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