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Surgical thoracoscopy, commonly known as video-assisted thoracoscopic surgery (VATS), is a minimally invasive surgical procedure used to access the thoracic cavity. This technique involves making a small incision, typically located between the fifth or sixth ribs, just below the tip of the scapula. The procedure begins with the identification of the pleura, the membrane surrounding the lungs, through digital palpation. A trocar is then inserted to facilitate the introduction of a thoracoscope, which is a specialized camera that allows the surgeon to visualize the thoracic cavity on a monitor. To perform the necessary surgical interventions, two or more additional incisions are made to accommodate the insertion of surgical instruments. In the context of CPT® Code 32655, the procedure specifically addresses the treatment of one or more blebs or bullae, which are air-filled sacs that can form on the lung surface and may lead to complications such as pneumothorax. The thoracic cavity is inspected using the thoracoscope, and any pleural adhesions are carefully dissected using diathermy or sharp and blunt dissection techniques. To locate any leaking blebs or bullae, sterile saline is instilled into the pleural space. Once identified, the bleb or bulla is grasped with an endoscopic grasper or forceps, and a linear endoscopic stapler and cutter are utilized to perform resection-plication. This involves placing multiple lines of staples at the site of the bleb or bulla to effectively seal it and prevent further air leakage. Additionally, the procedure may include other pleural interventions, such as a parietal pleurectomy, which are encompassed within the scope of CPT® Code 32655. This comprehensive approach allows for effective management of pleural conditions while minimizing the invasiveness of traditional thoracic surgery.
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The procedure described by CPT® Code 32655 is indicated for the treatment of conditions related to the presence of blebs or bullae on the lung surface, which can lead to complications such as pneumothorax. The following are specific indications for performing this surgical thoracoscopy:
The surgical procedure associated with CPT® Code 32655 involves several key steps that are performed in a structured manner to ensure effective treatment of the identified blebs or bullae. The following outlines the procedural steps:
After the completion of the surgical thoracoscopy procedure, patients are typically monitored for any immediate complications. Post-procedure care may include pain management, monitoring for signs of pneumothorax, and ensuring proper lung expansion. Patients may be advised to avoid strenuous activities for a specified period to facilitate recovery. Follow-up appointments are essential to assess the surgical site and ensure that there are no complications, such as infection or recurrence of symptoms. The overall recovery time may vary depending on the individual patient's health status and the extent of the procedure performed.
| Short Descr | THORACOSCOPY RESECT BULLAE | Medium Descr | THORACOSCOPY W/RESECTION BULLAE W/WO PLEURAL PX | Long Descr | Thoracoscopy, surgical; with resection-plication of bullae, includes any pleural procedure when performed | 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) | 1 - 150% payment adjustment for bilateral procedures applies. | 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) | P8I - Endoscopy - other | 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.
| 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. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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.) | 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). | 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) | 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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| 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. |