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The procedure described by CPT® Code 32658 involves a surgical thoracoscopy, which is a minimally invasive technique used to access the thoracic cavity. Specifically, this procedure focuses on the pericardial sac, the fibrous membrane that encases the heart. During this operation, the physician utilizes video-assisted thoracoscopic surgery (VATS) to remove either a clot or a foreign body that may be present within the pericardial sac. The approach typically begins with the creation of a small incision between the ribs, often located at the sixth or seventh intercostal space along the anterior axillary line. This incision allows for the introduction of a videothoracoscope, a specialized camera that provides visual access to the thoracic cavity. To facilitate the procedure, two additional portal incisions are made at the posterior axillary line, generally at the fifth and eighth intercostal spaces, which enable the insertion of surgical instruments necessary for the operation. As part of the procedure, one lung is intentionally collapsed to provide a clearer view and access to the pericardial sac. The inferior pulmonary ligament is divided to further enhance access, and the phrenic nerve, which is crucial for diaphragm function, is carefully identified and protected throughout the process. In cases where blunt trauma has led to the formation of a pericardial blood clot, the surgeon will grasp and retract the pericardium away from the heart to gain better access. Endoscopic scissors are then introduced to nick the pericardium, allowing for the evacuation of blood and fluid. The surgeon examines the pericardium to locate the blood clot or any foreign body that may need to be removed. Once the clot or foreign body is successfully extracted, any bleeding is controlled, and chest tubes may be placed as necessary to facilitate drainage. Finally, the incisions made during the procedure are closed, completing the surgical intervention.
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The procedure described by CPT® Code 32658 is indicated for specific clinical scenarios where intervention is necessary to address issues within the pericardial sac. The following conditions may warrant the performance of this surgical thoracoscopy:
The surgical thoracoscopy procedure for CPT® Code 32658 involves several critical steps to ensure effective access and removal of the clot or foreign body from the pericardial sac. The following procedural steps are performed:
After the completion of the thoracoscopy procedure, patients may require specific post-procedure care to ensure proper recovery. Monitoring for any signs of complications, such as bleeding or infection, is essential. Patients may experience some discomfort at the incision sites, which can be managed with appropriate pain relief measures. The placement of chest tubes, if performed, will require monitoring for drainage and potential air leaks. Follow-up appointments will be necessary to assess the healing process and to ensure that the pericardial sac is functioning normally without any residual issues. The healthcare team will provide instructions regarding activity restrictions and signs to watch for that may indicate complications, ensuring a safe recovery process.
| Short Descr | THORACOSCOPY W/SAC FB REMOVE | Medium Descr | THORACOSCOPY W/RMVL CLOT/FB FROM PERICARDIAL SAC | Long Descr | Thoracoscopy, surgical; with removal of clot or foreign body from pericardial sac | 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) | P8I - Endoscopy - other | MUE | 1 | CCS Clinical Classification | 49 - Other OR heart 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) |
| 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). | 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). | 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). | 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) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
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| 2011-01-01 | Changed | Short description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |