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Diagnostic thoracoscopy, as described by CPT® Code 32604, is a minimally invasive surgical procedure that allows for direct visualization of the pericardial sac, which is the double-walled sac containing the heart. This procedure is performed to obtain tissue samples through biopsy, aiding in the diagnosis of various cardiac conditions. During the procedure, a thoracoscope—a thin, flexible tube equipped with a camera and light—is inserted through a small incision made at either the right or left midaxillary line, typically at the sixth or seventh intercostal space. This access point enables the physician to examine the pericardial sac closely for any abnormalities, such as lesions or signs of disease. If necessary, additional small incisions may be created to facilitate the introduction of surgical instruments for further examination or intervention. The procedure may involve aspirating fluid from the pericardial sac for laboratory analysis, which is crucial for diagnosing conditions like pericardial effusion, pericarditis, or pericardial constriction. Throughout the thoracoscopy, the cardiac chambers, epicardium, and pericardium are meticulously inspected, and photographs may be taken to document findings. This comprehensive approach ensures that any pathological changes can be identified and addressed appropriately.
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Diagnostic thoracoscopy (CPT® Code 32604) is indicated for several specific conditions and symptoms that warrant direct visualization and biopsy of the pericardial sac. The following are the primary indications for this procedure:
The procedure for diagnostic thoracoscopy involves several critical steps to ensure effective visualization and sampling of the pericardial sac. The following outlines the procedural steps:
Following the diagnostic thoracoscopy, patients are typically monitored for any immediate complications, such as bleeding or infection. Recovery may involve observation in a healthcare setting until the patient is stable. Patients may experience some discomfort at the incision sites, which can be managed with analgesics. Instructions for post-procedure care, including activity restrictions and signs of complications to watch for, will be provided. Follow-up appointments may be scheduled to discuss biopsy results and any further management based on the findings from the procedure.
| Short Descr | THORACOSCOPY WBX SAC | Medium Descr | THORACOSCOPY DX PERICARDIAL SAC W/BIOPSY SPX | Long Descr | Thoracoscopy, diagnostic (separate procedure); pericardial sac, with 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 | 62 - Other diagnostic cardiovascular procedures |
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. | 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). | 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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| 2019-03-06 | Changed | Per CPT Errata, Guideline typo fixed. |
| 2011-01-01 | Changed | Short description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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