© Copyright 2025 American Medical Association. All rights reserved.
Diagnostic thoracoscopy, as defined by CPT® Code 32606, is a minimally invasive surgical procedure that allows for direct visualization of the mediastinal space within the thoracic cavity. This procedure is typically performed to obtain tissue samples for diagnostic purposes. During the procedure, the patient is positioned in a lateral decubitus position, which involves lying on their side. This positioning facilitates access to the thoracic cavity. To enhance visibility and access, one lung is ventilated while the contralateral lung is collapsed, creating a working space within the thorax. The surgeon makes two or three small incisions in the chest wall to introduce a thoracoscope—a specialized instrument equipped with a camera and light source—along with other necessary surgical instruments. The thoracoscope is usually inserted at the sixth or seventh intercostal space, either along the middle axillary line or at the anterior or posterior axillary lines, depending on the specific clinical scenario. Once inside the thoracic cavity, the surgeon visualizes and examines the mediastinal structures, which may include the mediastinal pleura, thymus, lymph nodes, and any masses or lesions present. The procedure may also involve aspirating any fluid found in the mediastinal space and documenting any abnormalities through photographs. Tissue samples are collected from the mediastinal structures as needed, which can provide critical information for diagnosing various conditions affecting the mediastinum.
© Copyright 2025 Coding Ahead. All rights reserved.
Diagnostic thoracoscopy (CPT® Code 32606) is indicated for various clinical scenarios where visualization and biopsy of the mediastinal space are necessary. The following conditions may warrant this procedure:
The procedure for diagnostic thoracoscopy involves several key steps that ensure effective visualization and sampling of the mediastinal space:
After the diagnostic thoracoscopy is completed, the patient may require monitoring for any immediate complications related to the procedure. Post-procedure care typically includes managing pain at the incision sites and monitoring respiratory function. Patients may be advised to avoid strenuous activities for a specified period to allow for proper healing. Follow-up appointments may be scheduled to discuss biopsy results and any further management based on the findings from the procedure. It is essential to provide the patient with clear instructions regarding signs of complications, such as increased pain, fever, or difficulty breathing, which should prompt immediate medical attention.
| Short Descr | THORACOSCOPY W/BX MED SPACE | Medium Descr | THORACOSCOPY DX MEDIASTINAL SPACE W/BIOPSY SPX | Long Descr | Thoracoscopy, diagnostic (separate procedure); mediastinal space, 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 | 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) |
| 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). | 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 | 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) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2011-01-01 | Changed | Short description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
Get instant expert-level medical coding assistance.