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The procedure described by CPT® Code 32906 refers to a thoracoplasty performed using the Schede type or extrapleural technique, specifically with the closure of a bronchopleural fistula. Thoracoplasty is a surgical intervention that involves the removal of one or more ribs, which serves to eliminate the skeletal support on one side of the chest, leading to the collapse of the chest wall. This surgical approach is typically indicated for patients suffering from chronic thoracic empyema or pulmonary tuberculosis, as it aims to obliterate the pleural space that may be contributing to these conditions. The procedure can be executed in a single stage or as a multi-stage operation, depending on the complexity of the case and the extent of the disease. The standard surgical approach for this procedure is through a parascapular incision, which allows the surgeon access to the thoracic cavity. During the operation, a subperiosteal resection of multiple ribs is performed, commonly involving the removal of the first through the seventh ribs, although up to eleven ribs may be resected if necessary. The intercostal muscles are sectioned to facilitate access, and the intercostal nerve is identified and cut to prevent pain and discomfort post-surgery. An extensive skin and muscle flap is then raised, and the lung is carefully dissected away from the chest wall. To assist in maintaining the collapse of the pleural space, the costotransverse ligament may be divided, allowing the scapula and surrounding musculature to drop into the space. The procedure concludes with the partial closure of the extracostal muscle and skin over gauze packing, which promotes the formation of fresh granulation tissue that will eventually obliterate the empyema or cavitary space. In contrast to CPT® Code 32905, which involves thoracoplasty without the closure of a bronchopleural fistula, CPT® Code 32906 specifically includes the closure of such a fistula. This involves debriding the fistula of any necrotic and inflammatory material, followed by closure using sutures or staples, which may be reinforced with a local flap of pleura, pericardium, or mediastinal fatty tissue. In some cases, the repair may necessitate the creation of a vascularized muscle flap or omental flap to adequately cover the bronchial leak site.
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The procedure described by CPT® Code 32906 is indicated for specific conditions that necessitate surgical intervention to address complications within the thoracic cavity. The following are the primary indications for performing this procedure:
The thoracoplasty procedure as outlined in CPT® Code 32906 involves several critical steps to ensure effective treatment of the underlying conditions. The following procedural steps are performed:
After the thoracoplasty procedure is completed, patients typically require careful monitoring and post-operative care to ensure proper recovery. Expected post-procedure care includes managing pain, monitoring for signs of infection, and ensuring that the pleural space is adequately healing. Patients may need to remain in the hospital for a period of time to observe for any complications, such as respiratory distress or issues related to the closure of the bronchopleural fistula. Follow-up appointments will be necessary to assess the healing process and to ensure that the empyema or other underlying conditions are adequately resolved. Rehabilitation may also be recommended to help restore lung function and overall physical health following the surgery.
| Short Descr | REVISE & REPAIR CHEST WALL | Medium Descr | THORACOP SCHEDE TYP/XTRPLEURAL CLSR BRNCPLR FSTL | Long Descr | Thoracoplasty, Schede type or extrapleural (all stages); with closure of bronchopleural fistula | 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 |
| 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). | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery |
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