How To Use CPT Code 32652

CPT 32652 describes a thoracoscopy procedure that involves the surgical removal of the pleural layers surrounding the lungs, known as total pulmonary decortication. This article will provide an overview of CPT code 32652, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 32652?

CPT 32652 is a code used to describe a thoracoscopy procedure that involves the complete removal of the pleural layers surrounding the lungs, a process known as total pulmonary decortication. This procedure is performed using a video-assisted endoscopic approach, where the provider utilizes small incisions to access the pleural cavity and uses specialized instruments to remove adhesions and separate the pleura from the chest wall. The purpose of this procedure is to treat conditions such as empyema and pleural effusion by improving lung function and promoting better respiratory health.

2. Official Description

The official description of CPT code 32652 is: ‘Thoracoscopy, surgical; with total pulmonary decortication, including intrapleural pneumonolysis.’

3. Procedure

1. The patient is prepped, draped, and anesthetized, and one lung is collapsed while the other is ventilated.
2. The provider makes small incisions to access the pleural cavity and inserts a thoracoscope with a camera and grasping instruments.
3. The provider irrigates the cavity and collects fibrin and blood clot material for analysis.
4. Using sharp or blunt instruments, the provider breaks up adhesions and removes the thickened pleura covering the lung, known as the cortex.
5. Tears in the lung are closed as they occur during the procedure.
6. The lung is expanded, and any significant air leaks are identified and treated.
7. Chest tubes may be inserted to aid with drainage and lung expansion.
8. The instruments are removed, wounds are closed, and the patient’s lung expansion is confirmed.

4. Qualifying circumstances

CPT 32652 is typically performed on patients with conditions such as empyema and pleural effusion, where the removal of the pleural layers is necessary to improve lung function and alleviate symptoms. The procedure is performed by a qualified healthcare professional using a video-assisted endoscopic approach. It is important to note that this procedure is typically performed in an inpatient setting and may require collaboration with an anesthesiologist to ensure patient safety and comfort.

5. When to use CPT code 32652

CPT code 32652 should be used when a thoracoscopy procedure is performed to remove the pleural layers surrounding the lungs, specifically for total pulmonary decortication. This code should be used when the provider utilizes a video-assisted endoscopic approach and performs the procedure in its entirety, including intrapleural pneumonolysis. It is important to review the patient’s medical records and documentation to ensure that the procedure meets the criteria for CPT code 32652 before reporting it.

6. Documentation requirements

To support a claim for CPT code 32652, the healthcare professional must document the following information:

• Patient’s diagnosis and the medical necessity for total pulmonary decortication
• Details of the procedure, including the use of a video-assisted endoscopic approach
• Date of the procedure and the duration of the surgery
• Specific steps performed during the procedure, such as the removal of adhesions and the cortex
• Any complications or significant findings during the procedure
• Confirmation of adequate lung expansion and closure of wounds
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT code 32652, it is important to ensure that the procedure meets the criteria outlined in the code description. The provider should use the appropriate modifiers, if applicable, and follow any specific billing guidelines provided by the payer. It is also important to review any bundling or unbundling rules that may apply to ensure accurate and appropriate reimbursement for the procedure.

8. Historical information

CPT code 32652 was added to the Current Procedural Terminology system on January 1, 1994. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement, indicating that it is typically performed in an inpatient setting.

9. Examples

1. A patient with empyema undergoes a thoracoscopy procedure for total pulmonary decortication to improve lung function and alleviate symptoms.
2. A patient with pleural effusion undergoes a thoracoscopy procedure for total pulmonary decortication to remove the thickened pleura and promote better respiratory health.
3. A provider performs a thoracoscopy procedure for total pulmonary decortication on a patient with a history of recurrent pleural infections.
4. A patient with a chronic lung condition undergoes a thoracoscopy procedure for total pulmonary decortication to improve lung capacity and function.
5. A provider performs a thoracoscopy procedure for total pulmonary decortication on a patient with a traumatic injury to the chest, resulting in pleural adhesions.
6. A patient with a history of pleural effusion undergoes a thoracoscopy procedure for total pulmonary decortication to prevent further fluid accumulation.
7. A provider performs a thoracoscopy procedure for total pulmonary decortication on a patient with a lung infection that has not responded to other treatments.