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Surgical thoracoscopy, commonly known as video-assisted thoracoscopic surgery (VATS), is a minimally invasive surgical technique used to access the thoracic cavity. This procedure is specifically indicated for patients suffering from emphysema, a chronic lung condition characterized by the destruction of the air sacs (alveoli) in the lungs, leading to breathing difficulties. The primary goal of thoracoscopy with resection-plication for lung volume reduction surgery (LVRS) is to enhance the patient's exercise tolerance and overall quality of life by reducing the volume of the diseased lung tissue. Typically, this procedure targets the upper lobe of the lung, which is often the most affected area in emphysema patients. During the surgery, single lung ventilation is initiated on the side that is not being operated on, allowing for better visualization and access to the affected lung. The procedure involves making incisions in specific intercostal spaces to facilitate the insertion of surgical instruments and the thoracoscope, enabling the surgeon to perform the necessary resection and plication of the lung tissue. This approach not only minimizes recovery time compared to traditional open surgery but also reduces postoperative pain and complications, making it a preferred option for eligible patients.
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The procedure is indicated for patients with emphysema, which may present as either bullous or non-bullous forms. The primary symptoms and conditions that warrant this surgical intervention include:
The surgical procedure involves several critical steps to ensure effective lung volume reduction. The following outlines the procedural steps:
Post-procedure care involves monitoring the patient for any complications, such as air leaks or bleeding. Patients are typically observed in a recovery area until they are stable. The placement of chest tubes aids in the management of any fluid accumulation and ensures proper lung expansion. Patients may experience some pain and discomfort, which can be managed with appropriate analgesics. The expected recovery time varies, but many patients can return to normal activities within a few weeks, depending on their overall health and the extent of the surgery. Follow-up appointments are essential to assess lung function and overall recovery progress.
| Short Descr | THORACOSCOPY FOR LVRS | Medium Descr | THORACOSCOPY W/RESEXN-PLICAJ EMPHYSEMA LUNG UNIL | Long Descr | Thoracoscopy, surgical; with resection-plication for emphysematous lung (bullous or non-bullous) for lung volume reduction (LVRS), unilateral 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) | 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.
| 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) |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 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. | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2012-01-01 | Added | Added |