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Thoracoplasty, specifically the Schede type or extrapleural variant, is a surgical procedure aimed at addressing severe thoracic conditions such as chronic thoracic empyema and pulmonary tuberculosis. This operation involves the strategic removal of a number of ribs, which serves to eliminate the skeletal support on one side of the chest, leading to the intentional collapse of the chest wall. The primary goal of this procedure is to obliterate the pleural space, thereby preventing the accumulation of fluid or infection that can occur in conditions like empyema. The procedure can be performed in a single stage or as a multi-stage operation, depending on the severity of the condition and the specific needs of the patient. The standard surgical approach for thoracoplasty is typically through a parascapular incision, which allows for adequate access to the thoracic cavity. During the operation, the surgeon performs a subperiosteal resection of multiple ribs, commonly targeting the first through the seventh ribs, although up to eleven ribs may be removed if necessary. This extensive resection involves sectioning the intercostal muscles and identifying and cutting the intercostal nerve to facilitate the procedure. An extensive skin and muscle flap is then raised, allowing the lung to be dissected away from the chest wall. To assist in maintaining the collapse of the chest wall, the costotransverse ligament may be divided, enabling the scapula and extracostal musculature to drop into the newly created space. Following the rib resection and dissection, the extracostal muscle and skin are partially closed over gauze packing, which promotes the formation of fresh granulation tissue. This granulation tissue is crucial as it will eventually fill and obliterate the cavitary space or empyema, leading to improved patient outcomes. It is important to note that in CPT® Code 32905, the thoracoplasty procedure does not involve the closure of a bronchopleural fistula, which is a separate consideration addressed in CPT® Code 32906.
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The thoracoplasty procedure is indicated for specific chronic thoracic conditions that necessitate surgical intervention. The primary indications include:
The thoracoplasty procedure involves several critical steps, each designed to achieve the desired outcome of obliterating the pleural space. The procedural steps include:
Post-procedure care following thoracoplasty is essential for ensuring proper recovery and minimizing complications. Patients can expect a recovery period that may involve monitoring for any signs of infection or complications related to the surgical site. The formation of granulation tissue is a critical aspect of the healing process, as it aids in the obliteration of the pleural space. Patients may require follow-up visits to assess the healing process and ensure that the intended outcomes of the procedure are being achieved. Additionally, pain management strategies will be implemented to address any discomfort resulting from the surgery. Overall, the post-procedure phase is crucial for achieving optimal recovery and long-term success of the thoracoplasty procedure.
| Short Descr | REVISE & REPAIR CHEST WALL | Medium Descr | THORACOPLASTY SCHEDE TYPE/EXTRAPLEURAL | Long Descr | Thoracoplasty, Schede type or extrapleural (all stages); | 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 | 42 - Other OR therapeutic procedures on respiratory system |
| 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). | 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.) | 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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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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