2025 CPT code 32504
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Respiratory System Feed
Resection of apical lung tumor (e.g., Pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; with chest wall reconstruction.
Modifiers may be applicable. For example, if the procedure is significantly more complex than usual, modifier 22 (Increased Procedural Services) may be appropriate.If another distinct procedure is performed on the same side, such as a separate therapeutic wedge resection on a different lobe, modifier 59 (Distinct Procedural Service) should be appended.
Medical necessity for this procedure must be supported by documentation confirming the presence of an apical lung tumor, with or without invasion of surrounding structures, requiring surgical removal and chest wall reconstruction for optimal patient outcome.
The surgeon is responsible for the entire procedure, from patient preparation and anesthesia to the final closure of the incision.This includes accurate identification and resection of the tumor, managing any necessary resection of surrounding structures (chest wall, ribs, nerves, blood vessels), and performing a robust chest wall reconstruction.
In simple words: The doctor removes a tumor located at the top of the lung, which may be a Pancoast tumor. This surgery involves removing parts of the chest wall and ribs, as well as any affected nerves and blood vessels.The chest wall is then rebuilt, sometimes using a mesh-like material. The surgery is done through an incision in the chest, and a tool is used to spread the ribs apart for better access.Afterwards, the incision is closed with stitches or staples.
The procedure involves the removal of an apical lung tumor, often a Pancoast tumor.This includes resection of the chest wall, ribs, and any necessary neurovascular dissection. The procedure also includes chest wall reconstruction, potentially using prosthetic materials like mesh.The approach is via a thoracotomy, which is an incision into the chest cavity, either from the front or back, depending on the tumor's location. A rib spreader is used to enhance access to the operative field. Following the resection and reconstruction, the incision is closed with staples or sutures.
Example 1: A patient presents with a Pancoast tumor invading the chest wall and requiring rib resection and chest wall reconstruction. This scenario necessitates code 32504., A patient with a superior sulcus tumor (another type of apical lung tumor) requires resection of the tumor, a portion of the first rib, and reconstruction of the chest wall defect. Code 32504 accurately reflects this complex procedure., A patient has an apical lung tumor extending into nearby blood vessels necessitating careful dissection. The tumor, affected rib segments, and the involved portion of the chest wall are removed and the chest wall reconstructed. This scenario would also utilize code 32504.
Documentation should clearly describe the size and location of the apical tumor, the extent of chest wall involvement, the specific ribs resected, any neurovascular structures dissected, the type of chest wall reconstruction performed, and any intraoperative findings or complications.
- Revenue Code: P1G - MAJOR PROCEDURE - OTHER
- Specialties:Thoracic Surgery, Surgical Oncology
- Place of Service:Inpatient Hospital