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Official Description

Thoracoscopy, surgical; with resection of thymus, unilateral or bilateral

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 32673 refers to a surgical procedure known as thoracoscopy with resection of the thymus, which can be performed unilaterally or bilaterally. This minimally invasive technique involves accessing the thoracic cavity through small incisions, allowing for a detailed examination and surgical intervention on the thymus gland. The thymus is a small organ located in the upper chest, playing a crucial role in the immune system, particularly during childhood. Various thoracoscopic approaches can be utilized for thymectomy, including transcervical subxiphoid videothoracoscopic thymectomy, subxiphoid video-assisted thoracoscopic extended thymectomy, video-assisted thoracoscopic extended thymectomy, and transcervical thoracoscopically assisted thymectomy. The choice of approach influences the placement of ports and the specific surgical techniques employed. For instance, a left-sided approach typically involves a camera port positioned at the 5th intercostal space, along with two additional thoracic ports for optimal access and visualization. The procedure is characterized by the inflation of the hemithorax through the camera port, deflation of the left lung, and careful dissection of the thymic gland from surrounding structures, ensuring minimal trauma and promoting quicker recovery. Overall, this procedure is essential for addressing conditions related to the thymus, utilizing advanced techniques to enhance patient outcomes.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 32673 is indicated for various conditions related to the thymus gland. These indications may include:

  • Thymoma - A tumor originating from the thymus gland, which may require surgical resection for treatment.
  • Myasthenia Gravis - An autoimmune disorder that can be associated with thymic abnormalities, where thymectomy may improve symptoms.
  • Thymic Hyperplasia - An enlargement of the thymus gland that may necessitate surgical intervention.
  • Thymic Carcinoma - A rare type of cancer that arises from the thymus, requiring surgical removal.

2. Procedure

The surgical procedure for CPT® Code 32673 involves several detailed steps to ensure effective resection of the thymus gland. The following outlines the procedural steps:

  • Step 1: Port Placement - The procedure begins with the placement of a camera port at the 5th intercostal space on the left side of the chest. Two additional thoracic ports are established: one through a separate incision in the intercostal space and another on the midclavicular line at the 3rd intercostal space. This setup allows for optimal visualization and access to the thoracic cavity.
  • Step 2: Lung Management - Once the ports are in place, the hemithorax is inflated through the camera port, and the left lung is deflated to create a clear working space for the surgeon.
  • Step 3: Inspection and Dissection - The mediastinal pleural space is inspected, and dissection of the surrounding fat begins at the left pericardiophrenic angle. The thymic gland is carefully dissected from the retrosternal chest wall, isolating the left inferior horn of the thymus from the pericardium.
  • Step 4: Mobilization of the Thymus - The pleura is incised at the superior aspect of the mediastinum, allowing the thymus to be mobilized upwards. The thymic tissue is then dissected from the aortopulmonary window under thoracoscopic visualization.
  • Step 5: Further Dissection - The thymus is dissected from the right mediastinal pleura and right inferior horn. Cervical fat is also dissected from the retrosternal and jugular regions to expose the upper horns of the thymus.
  • Step 6: Vein Management - The innominate vein is located on the left side, and the superior horns of the thymus are dissected. The thymus veins are then exposed, clipped, and ligated to prevent bleeding.
  • Step 7: Resection and Removal - The thymus gland, along with any fatty tissue from the mediastinum and cervical neck, is completely resected. The tissue is placed in an endobag for safe removal through the working port at the 5th intercostal space.
  • Step 8: Closure and Recovery - After ensuring that any bleeding is controlled, the left lung is inflated, and chest tubes are placed as necessary. Finally, the portal wounds are closed to complete the procedure.

3. Post-Procedure

Post-procedure care following a thoracoscopic thymectomy involves monitoring the patient for any complications, such as bleeding or infection. Patients may require chest tubes to facilitate lung re-expansion and drainage of any fluid accumulation. Recovery typically includes pain management and gradual resumption of normal activities, with specific instructions provided by the surgical team. Follow-up appointments are essential to assess healing and monitor for any recurrence of symptoms related to the thymus gland.

Short Descr THORACOSCOPY W/THYMUS RESECT
Medium Descr THORACOSCOPY RESEXN THYMUS UNI/BILATERAL
Long Descr Thoracoscopy, surgical; with resection of thymus, unilateral or bilateral
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 12 - Other therapeutic endocrine 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)
GC This service has been performed in part by a resident under the direction of a teaching physician
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
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.
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.
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).
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).
CR Catastrophe/disaster related
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
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