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A thoracic sympathectomy is a surgical procedure performed through thoracoscopy, which is also known as video-assisted thoracoscopic surgery (VATS). This minimally invasive technique allows surgeons to access the thoracic cavity with reduced trauma compared to traditional open surgery. During the procedure, the patient is positioned in a semi-Fowler's position, which involves sitting up slightly with the arms positioned away from the body. A roll is placed behind the shoulder to facilitate access to the upper sympathetic chain, which is a network of nerves located in the thoracic region. To perform the surgery, one-lung ventilation is utilized, allowing the contralateral lung to collapse. This collapse is essential as it creates more space within the thoracic cavity, enabling the surgeon to visualize and operate on the sympathetic chain effectively. The procedure involves making one or two small incisions in the chest wall through which a thoracoscope is inserted. The thoracoscope is equipped with a camera and light source, providing a clear view of the sympathetic chain located beneath the parietal pleura, which is the outer membrane covering the lungs. The sympathetic chain runs vertically along the necks of the ribs in the upper vertebral region. The surgeon then uses hook cautery to divide the sympathetic chain, which may involve cutting and coagulating the nerve fibers. In some cases, a segment of the chain may be excised entirely. The goal of the procedure is to obliterate the ganglia by completely severing the sympathetic chain, which can alleviate conditions such as hyperhidrosis, thoracic outlet syndrome, reflex sympathetic dystrophy, and chronic pancreatic pain. After the sympathetic chain is transected, the pleura is carefully divided laterally to the chain, and any aberrant nerve bundles are identified and severed to prevent unintended nerve regeneration. The ends of the sympathetic nerve bundles are cauterized to further inhibit regrowth. The specific level at which the sympathetic chain is transected depends on the condition being treated; for instance, levels T2-T5 are targeted for hyperhidrosis, T1-T3 for thoracic outlet syndrome and reflex sympathetic dystrophy, and T4-T10 for chronic pancreatic pain. Once the procedure is completed, a chest tube is placed to facilitate drainage, and the subcutaneous tissue is closed. The lungs are then expanded, the chest tube is removed, and a subcuticular suture is applied to finalize the surgical site. If necessary, the procedure may be repeated on the opposite side to achieve bilateral results.
© Copyright 2025 Coding Ahead. All rights reserved.
The thoracic sympathectomy procedure is indicated for several specific conditions that involve the sympathetic nervous system. These indications include:
The thoracic sympathectomy procedure involves several critical steps to ensure successful outcomes. The procedure begins with the patient being placed in a semi-Fowler's position, which allows optimal access to the thoracic cavity. The arms are abducted, and a roll is positioned behind the shoulder to facilitate access to the upper sympathetic chain. Following this, one-lung ventilation is initiated, resulting in the collapse of the contralateral lung. This technique utilizes gravity to pull the lung downwards and away from the chest wall, creating a clearer surgical field. Next, one or two small incisions are made in the chest wall, through which a thoracoscope is inserted. The thoracoscope, equipped with a camera and light source, provides visualization of the sympathetic chain located beneath the parietal pleura. The surgeon carefully identifies the sympathetic chain, which runs vertically over the necks of the ribs in the upper vertebral region. Using hook cautery, the surgeon divides the sympathetic chain, effectively cutting and coagulating the nerve fibers. In some cases, a segment of the sympathetic chain may be excised entirely to achieve the desired therapeutic effect. Once the sympathetic chain is transected, the pleura is divided laterally to the chain, allowing the surgeon to locate and sever any aberrant nerve bundles that may interfere with the procedure's success. The sympathetic nerve bundles are then separated, and the ends are cauterized to prevent regrowth, which is crucial for ensuring long-term relief from the symptoms associated with the conditions being treated. The specific level of transection is determined by the condition being addressed; for hyperhidrosis, the sympathetic chain is divided at levels T2-T5, while for thoracic outlet syndrome and reflex sympathetic dystrophy, the transection occurs at levels T1-T3. For chronic pancreatic pain, the transection is performed at levels T4-T10. Upon completion of the transection, a chest tube is placed to facilitate drainage of any fluid or air that may accumulate in the thoracic cavity. The subcutaneous tissue is then closed, and the lungs are expanded to restore normal respiratory function. After ensuring that the surgical site is secure, the chest tube is removed, and a subcuticular suture is applied to finalize the closure. If necessary, the procedure may be repeated on the opposite side to achieve bilateral results, depending on the patient's specific needs.
After the thoracic sympathectomy, patients are typically monitored for any complications related to the procedure. Post-operative care may include pain management, monitoring for signs of infection, and ensuring proper lung expansion. Patients may experience some discomfort at the incision sites, which is usually managed with prescribed analgesics. The recovery period can vary depending on the individual and the extent of the procedure, but many patients can expect to resume normal activities within a few weeks. Follow-up appointments are essential to assess the effectiveness of the procedure and to monitor for any potential complications or recurrence of symptoms. It is important for patients to adhere to their post-operative care instructions and attend all scheduled follow-up visits to ensure optimal recovery and outcomes.
| Short Descr | THORACOSCOPY W/ TH NRV EXC | Medium Descr | THORACOSCOPY W/THORACIC SYMPATHECTOMY | Long Descr | Thoracoscopy, surgical; with thoracic sympathectomy | 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 | 9 - Other OR therapeutic nervous system procedures |
| 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). | 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). | 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). | 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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| 2011-01-01 | Changed | Short description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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