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The procedure described by CPT® Code 32540 refers to the surgical intervention known as extrapleural enucleation of empyema, commonly referred to as empyemectomy. Empyema is characterized by the accumulation of pus, inflammatory fluid, and debris within the pleural cavity, typically resulting from an untreated infection in that space. This condition can lead to significant complications if not addressed promptly. The term "extrapleural enucleation" indicates that the surgical approach involves removing the empyema along with the surrounding tissue that has become involved due to the inflammatory process. This procedure is indicated when the empyema has progressed to a stage where it has penetrated through both the visceral and parietal pleura, leading to adhesions with adjacent structures. The surgical technique involves making an incision in the chest over the area of the empyema, allowing the surgeon to assess the extent of the disease and the involvement of surrounding tissues. The goal is to meticulously dissect and remove the empyema sac and any affected extrapleural tissue while ensuring that the sac remains intact to prevent spillage of its contents. Following the removal, chest tubes may be placed to facilitate drainage, and the incision is subsequently closed to promote healing.
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The procedure of extrapleural enucleation of empyema (empyemectomy) is indicated for patients presenting with the following conditions:
The extrapleural enucleation of empyema involves several critical procedural steps that ensure the effective removal of the empyema while minimizing complications:
After the extrapleural enucleation of empyema, patients typically require monitoring for any signs of complications, such as infection or bleeding. The placement of chest tubes allows for the continuous drainage of any residual fluid, which is essential for recovery. Patients may experience discomfort at the incision site, and pain management will be an important aspect of post-operative care. The expected recovery period can vary based on the individual patient's condition and the extent of the surgery performed. Follow-up appointments will be necessary to assess healing and to remove any chest tubes once drainage has stabilized.
| Short Descr | REMOVAL OF LUNG LESION | Medium Descr | EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY | Long Descr | Extrapleural enucleation of empyema (empyemectomy) | 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) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 42 - Other OR therapeutic procedures on respiratory system |
| 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. | 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. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 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) |
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| Pre-1990 | Added | Code added. |
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