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Thoracoscopy, as defined by CPT® Code 32601, is a diagnostic procedure that allows for the examination of the lungs, pericardial sac, mediastinal, or pleural space without the need for a biopsy. This procedure employs various techniques to gain access to the thoracic cavity, enabling healthcare professionals to visually inspect the pleura and lungs for any abnormalities. One common method involves blunt entry, where a clamp is passed over a rib and through the pleura, allowing for direct visualization of the pleural space. This ensures that there is adequate space for the insertion of the thoracoscope, which is then introduced under direct vision. The thoracoscope facilitates a thorough inspection of the pleura and lung, where any irregularities can be noted, and fluid can be evacuated using suction catheters if necessary. Another technique may involve making a small intercostal incision to insert a trocar into the intercostal space, which is the area between two ribs. This method may induce an artificial pneumothorax by injecting air into the pleural space, enhancing the visualization of the lung and pleura. The thoracoscope is then inserted through the trocar, allowing for a detailed examination. While diagnostic procedures are often performed through a single incision, additional small incisions may be made to introduce other surgical instruments as needed. In cases where the mediastinum or pericardial sac requires evaluation, the thoracoscope can be introduced at the right or left midaxillary line and the sixth or seventh intercostal space. Alternatively, for mediastinal disease assessment, a port may be placed in the subxiphoid region for access. During the procedure, the mediastinum or pericardial sac is visualized, and any abnormalities are documented. If the mediastinal space is being evaluated, structures such as the carina, main bronchi, and lymph nodes are examined. For pericardial sac evaluation, an incision is made in the pericardium to aspirate fluid for laboratory analysis, while the cardiac chambers, epicardium, and pericardium are inspected for lesions or implants. Throughout the procedure, photographs may be taken to document findings. Upon completion, the thoracoscope is withdrawn, air is evacuated from the pleural space, and a chest tube is placed to facilitate drainage if necessary.
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The diagnostic thoracoscopy procedure, as described by CPT® Code 32601, is indicated for various clinical scenarios where visual inspection of the thoracic cavity is necessary. The following conditions may warrant this procedure:
The procedure for diagnostic thoracoscopy involves several key steps that ensure a thorough examination of the thoracic cavity. The following procedural steps are typically followed:
Following the diagnostic thoracoscopy, patients are typically monitored for any immediate complications. Post-procedure care may include managing pain, monitoring for signs of infection, and ensuring proper drainage if a chest tube has been placed. Patients may be advised on activity restrictions and follow-up appointments to discuss findings and any further management required based on the results of the procedure. Recovery time can vary, but many patients are able to resume normal activities within a few days, depending on their overall health and the extent of the procedure performed.
| Short Descr | THORACOSCOPY DIAGNOSTIC | Medium Descr | THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX | Long Descr | Thoracoscopy, diagnostic (separate procedure); lungs, pericardial sac, mediastinal or pleural space, without biopsy | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | 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) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8I - Endoscopy - other | MUE | 1 | CCS Clinical Classification | 40 - Other diagnostic procedures of respiratory tract and mediastinum |
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) |
| 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). | 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. | 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. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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| 2024-01-01 | Changed | Guideline added. |
| 2012-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Medium description changed. Short description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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