How To Use CPT Code 32674

CPT 32674 describes a thoracoscopy procedure that involves visualizing the chest cavity and the mediastinal lymph nodes to remove them. 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 32674?

CPT 32674 can be used to describe a thoracoscopy procedure that is performed to remove mediastinal lymph nodes. During this procedure, a provider makes an incision in the chest and inserts a trocar, or port, to hold instruments. A flexible or rigid endoscope with a video camera attached is then inserted to view and remove the lymph nodes. Other operating instruments are also inserted through additional trocars to perform the excision. The provider sutures the excised area and inserts a chest tube for drainage.

2. Official Description

The official description of CPT code 32674 is: ‘Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure)’. The notes for this code specify the lymph nodes included in the mediastinal region for both the right and left sides. It also provides a list of other codes that can be reported in conjunction with 32674.

3. Procedure

1. During a thoracoscopy procedure, the provider makes an incision in the chest.
2. A trocar is inserted to hold instruments used during the procedure.
3. A flexible or rigid endoscope with a video camera attached is inserted through the trocar to visualize the lymph nodes.
4. Additional operating instruments are inserted through other trocars to perform the excision of the lymph nodes.
5. The provider sutures the excised area and inserts a chest tube for drainage.

4. Qualifying circumstances

Thoracoscopy with mediastinal and regional lymphadenectomy is typically performed to treat lung cancer. Patients who require this procedure have lymph nodes in the mediastinal region that need to be removed. It is important to note that this code should be reported in addition to the code for the primary procedure. Other qualifying circumstances may vary depending on the specific case and the provider’s judgment.

5. When to use CPT code 32674

CPT code 32674 should be used when a thoracoscopy procedure is performed to remove mediastinal and regional lymph nodes. It is important to report this code in addition to the code for the primary procedure. The primary procedure may involve the lungs or pleura, and the thoracoscopy with lymphadenectomy is an additional component of the overall surgical treatment.

6. Documentation requirements

To support a claim for CPT code 32674, the provider must document the following information:

• Indication for the thoracoscopy procedure and the need for mediastinal and regional lymphadenectomy
• Details of the procedure, including the specific lymph nodes removed
• Date of the procedure
• Start and end time of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 32674, ensure that the procedure meets the criteria for thoracoscopy with mediastinal and regional lymphadenectomy. It is important to report this code in addition to the code for the primary procedure. The notes for this code provide a list of other codes that can be reported in conjunction with 32674. It is also important to follow any specific billing guidelines provided by the payer or coding guidelines.

8. Historical information

CPT code 32674 was added to the Current Procedural Terminology system on January 1, 2012. It has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A provider performs a thoracoscopy procedure with mediastinal and regional lymphadenectomy to remove lymph nodes in a patient with lung cancer.
2. During a thoracoscopy procedure, a provider removes mediastinal lymph nodes from a patient with a suspected tumor in the chest.
3. A patient undergoes a thoracoscopy with mediastinal and regional lymphadenectomy to remove lymph nodes as part of their treatment for lung cancer.
4. A provider performs a thoracoscopy procedure to remove mediastinal and regional lymph nodes in a patient with a history of lung disease.
5. During a thoracoscopy procedure, a provider excises mediastinal lymph nodes from a patient with a known malignancy.
6. A patient undergoes a thoracoscopy with mediastinal and regional lymphadenectomy to remove lymph nodes for further examination and staging of their lung cancer.
7. A provider performs a thoracoscopy procedure to remove mediastinal lymph nodes in a patient with a suspected metastasis from another primary tumor.
8. During a thoracoscopy procedure, a provider excises mediastinal and regional lymph nodes to determine the extent of disease in a patient with lung cancer.
9. A patient undergoes a thoracoscopy with mediastinal and regional lymphadenectomy to remove lymph nodes as part of their treatment plan for lung cancer.
10. A provider performs a thoracoscopy procedure to remove mediastinal lymph nodes in a patient with a recurrent tumor in the chest.