How To Use CPT Code 32503

CPT 32503 describes the resection of an apical lung tumor, including chest wall resection, rib(s) resection(s), and neurovascular dissection, when performed, without chest wall reconstruction. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 32503?

CPT 32503 can be used to describe the surgical removal of an apical lung tumor without the need for chest wall reconstruction. This code is used when the provider performs a thoracotomy, makes an incision in the thorax, to access the tumor at the top of the lung. The provider may also perform resections of the chest wall, ribs, nerves, or blood vessels if the tumor has spread into nearby tissue. The incision is closed with staples or stitches, and this code represents a service that does not involve chest wall reconstruction.

2. Official Description

The official description of CPT code 32503 is: ‘Resection of apical lung tumor (eg, Pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; without chest wall reconstruction(s).’

3. Procedure

1. The provider prepares the patient for surgery and administers anesthesia.
2. An incision, called a thoracotomy, is made in the thorax to access the apical lung tumor.
3. If necessary, the provider may use a rib spreader to separate the ribs and gain better access to the lungs.
4. The provider removes the apical lung tumor, such as a Pancoast tumor, and may also perform resections of the chest wall, ribs, nerves, or blood vessels if the tumor has spread into nearby tissue.
5. The incision is closed using staples or stitches.

4. Qualifying circumstances

CPT 32503 is performed on patients with an apical lung tumor, such as a Pancoast tumor, that requires surgical removal. The procedure may also involve resections of the chest wall, ribs, nerves, or blood vessels if the tumor has spread into nearby tissue. Chest wall reconstruction is not performed during this procedure.

5. When to use CPT code 32503

CPT code 32503 should be used when the provider performs the resection of an apical lung tumor without the need for chest wall reconstruction. If the procedure involves chest wall reconstruction, CPT code 32504 should be used instead.

6. Documentation requirements

To support a claim for CPT 32503, the provider must document the following information:

• Patient’s diagnosis of an apical lung tumor
• Details of the procedure performed, including the resection of the tumor and any additional resections of the chest wall, ribs, nerves, or blood vessels
• Method of closure used for the incision (staples or stitches)

7. Billing guidelines

When billing for CPT 32503, ensure that the procedure performed is the resection of an apical lung tumor without chest wall reconstruction. Use CPT code 32504 if chest wall reconstruction is performed. It is important to follow the specific guidelines provided by the payer and to accurately document the procedure performed to support the claim.

8. Historical information

CPT 32503 was added to the Current Procedural Terminology system on January 1, 2006. There have been no updates to the code since its addition.

9. Examples

1. A thoracic surgeon performing the resection of an apical lung tumor without chest wall reconstruction.
2. A cardiothoracic surgeon removing a Pancoast tumor from the apex of the lung.
3. A pulmonologist performing the resection of an apical lung tumor and resecting a rib due to tumor involvement.
4. A thoracic surgeon removing an apical lung tumor and performing neurovascular dissection to ensure complete tumor removal.
5. A surgical oncologist performing the resection of an apical lung tumor and resecting a portion of the chest wall due to tumor invasion.
6. A thoracic surgeon removing an apical lung tumor and resecting multiple ribs to achieve complete tumor removal.
7. A cardiothoracic surgeon performing the resection of an apical lung tumor and resecting a blood vessel due to tumor involvement.
8. A pulmonologist removing an apical lung tumor and resecting a nerve to ensure complete tumor removal.
9. A thoracic surgeon performing the resection of an apical lung tumor and closing the incision with staples.
10. A surgical oncologist removing a Pancoast tumor and closing the incision with stitches.