© Copyright 2025 American Medical Association. All rights reserved.
Thoracoscopy, surgical, with removal of lung (pneumonectomy) is a minimally invasive surgical procedure that involves the use of a thoracoscope, which is a specialized instrument designed for visualizing the thoracic cavity. This procedure is commonly referred to as video-assisted thoracoscopic surgery (VATS). The thoracoscope is inserted through a small incision in the chest wall, typically in the 7th or 8th intercostal space along the mid to anterior axillary line on the affected side. This allows the surgeon to inspect the thoracic structures directly. A larger working incision is then made in the anterolateral chest wall at the 4th intercostal space to facilitate access to the thoracic cavity. Once inside the pleural space, air is injected to create an artificial pneumothorax, which helps to expand the pleural cavity and provides better visualization of the lung and surrounding structures. The surgeon explores the pleura and lung to assess for any signs of metastatic disease and to evaluate whether the lung is resectable. The procedure involves dividing the pleura at the pleural-parenchymal reflection, exploring the hilar structures, and identifying the pulmonary veins, which are then staple ligated to control blood flow. Further dissection of the pleura is performed as necessary, followed by identification and division of the pulmonary arteries. The main bronchus is encircled, stapled, and divided, allowing for the complete mobilization of the lung. An endopouch is introduced to facilitate the removal of the lung through the working incision after it has been placed in the pouch. After the lung is removed, the surgeon controls any bleeding, removes the instruments, places a chest tube to assist with drainage, and finally closes the incisions. This procedure is typically indicated for patients with significant lung disease, such as lung cancer, where the removal of the affected lung is necessary for treatment.
© Copyright 2025 Coding Ahead. All rights reserved.
The surgical procedure of thoracoscopy with pneumonectomy is indicated for various conditions affecting the lung. The following are the explicitly provided indications for performing this procedure:
The procedure of thoracoscopy with pneumonectomy involves several critical steps that ensure the safe and effective removal of the lung. Each step is detailed as follows:
Post-procedure care following a thoracoscopy with pneumonectomy is critical for patient recovery. After the surgery, patients are typically monitored for any complications, such as bleeding or infection. The placement of a chest tube is essential for draining any fluid or air that may accumulate in the pleural space, which helps to prevent complications such as pneumothorax. Patients may experience pain at the incision sites, which can be managed with appropriate analgesics. Recovery time can vary, but patients are generally advised to avoid strenuous activities and heavy lifting for a specified period to allow for proper healing. Follow-up appointments are necessary to monitor the patient's recovery and to assess lung function and overall health status.
| Short Descr | THORACOSCOPY PNEUMONECTOMY | Medium Descr | THORACOSCOPY W/PNEUMONECTOMY | Long Descr | Thoracoscopy, surgical; with removal of lung (pneumonectomy) | 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. | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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) |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2012-01-01 | Added | Added |