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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. In the context of CPT® Code 32670, this procedure specifically involves the surgical removal of two lobes of the right lung, a process referred to as bilobectomy. The procedure is performed through small incisions in the chest wall, allowing for reduced recovery time and less postoperative pain compared to traditional open surgery. During the procedure, single left lung ventilation is established to facilitate access and visibility within the thoracic cavity. A 1 cm portal incision is made at the 7th or 8th intercostal space in the anterior axillary line to accommodate the camera, while a second portal incision is created posteriorly at the same intercostal spaces. Additionally, a larger 4 cm access incision is made over the 3rd, 4th, or 5th interspace, depending on the specific lobes being resected. The entry into the pleural space is followed by the injection of air to induce an artificial pneumothorax, which enhances visualization of the lung and surrounding structures. The procedure includes exploration for metastatic disease, identification and ligation of pulmonary veins, and careful dissection of the lung parenchyma to ensure complete removal of the targeted lobes. This comprehensive approach aims to achieve effective surgical outcomes while minimizing trauma to the patient.
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The procedure described by CPT® Code 32670 is indicated for patients requiring the surgical removal of two lobes of the right lung due to various conditions. These may include:
The surgical procedure for CPT® Code 32670 involves several critical steps to ensure the successful removal of the two lobes of the right lung. The process begins with the establishment of single left lung ventilation, which allows the surgeon to operate on the right lung while minimizing interference with the left lung's function.
Post-procedure care following a bilobectomy involves monitoring the patient for complications such as bleeding, infection, or respiratory issues. The chest tube placed during surgery will typically remain in place for a period to facilitate drainage of any fluid or air that may accumulate in the pleural space. Patients are usually advised to engage in deep breathing exercises to promote lung expansion and prevent atelectasis. Recovery time may vary, but patients can generally expect a hospital stay of several days, followed by a gradual return to normal activities as they heal. Follow-up appointments will be necessary to assess recovery and lung function.
| Short Descr | THORACOSCOPY BILOBECTOMY | Medium Descr | THORACOSCOPY W/BILOBECTOMY | Long Descr | Thoracoscopy, surgical; with removal of two lobes (bilobectomy) | 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) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 36 - Lobectomy or pneumonectomy |
This is a primary code that can be used with these additional add-on codes.
| 32668 | Addon Code MPFS Status: Active Code APC C Thoracoscopy, surgical; with diagnostic wedge resection followed by anatomic lung resection (List separately in addition to code for primary procedure) | 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. | 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) | 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) |
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| 2012-01-01 | Added | Added |