2025 CPT code 32220
(Active) Effective Date: N/A Revision Date: N/A Surgery - Incision Procedures on the Lungs and Pleura Surgery Feed
Total pulmonary decortication; removal of fibrous layer restricting lung expansion.
Modifiers may be applicable depending on the circumstances of the procedure (e.g., modifier 59 for distinctly separate procedure from another performed on the same day; modifiers for anesthesia services).
Medical necessity for total decortication is established when a patient presents with symptomatic restrictive lung disease due to a thick fibrous peel. This peel, often a consequence of empyema, trauma, or infection, significantly impairs lung function, leading to shortness of breath, chest pain, and reduced quality of life.Decortication is medically necessary to restore lung expansion and alleviate the patient’s symptoms.
The surgeon's responsibilities include patient preparation, anesthesia administration, incision creation (thoracotomy or VATS), careful removal of fibrous tissue, drainage of fluid/pus, lung re-expansion verification, wound closure, and post-operative care.The anesthesiologist is responsible for managing anesthesia throughout the procedure.
In simple words: This surgery removes a thick, scar-like layer around the lung that prevents it from expanding properly. The doctor makes an incision in the chest, removes the scar tissue, and drains any fluid or pus.This helps the lungs work better.
Total pulmonary decortication is a surgical procedure involving the complete removal of a restrictive fibrous layer surrounding the lung, thereby restoring normal lung expansion.The procedure may be performed via a thoracotomy (open chest surgery) or minimally invasive video-assisted thoracoscopic surgery (VATS), depending on the patient's condition and the surgeon's preference.It entails meticulous dissection and removal of the fibrous membrane, along with drainage of any accumulated fluid or pus. The surgical approach necessitates careful attention to avoid lung injury and ensure complete removal of the restrictive tissue.
Example 1: A patient presents with chronic empyema (persistent pleural infection) resulting in a thick, restrictive fibrous peel around the lung. Total decortication is performed via a thoracotomy to remove the peel and restore lung function., A patient with post-traumatic fibrothorax (fibrous tissue buildup in the pleural space after chest trauma) experiences significant shortness of breath.A minimally invasive VATS decortication is performed to remove the fibrous tissue, improving lung expansion and respiratory function., A patient with a history of lung infection has developed a thick fibrous capsule around a portion of one lung, significantly impacting their breathing. A decision is made for a total decortication using a thoracotomy approach due to the extent of the fibrosis and the need for complete visualization during the procedure. The surgeon carefully removes the thick fibrous tissue and ensures complete lung re-expansion.
Preoperative: Detailed patient history (including respiratory symptoms, imaging studies, and prior medical history), physical examination findings, chest x-rays, CT scans, and complete blood count.Intraoperative: Operative report detailing the surgical approach (thoracotomy or VATS), the extent of fibrous tissue removed, the presence of infection or fluid, and any complications encountered.Postoperative: Pathology report of the removed tissue, postoperative chest x-rays or CT scans to assess lung re-expansion, and documentation of any postoperative complications.
** Code 32220 should only be reported when the decortication is a separate procedure and not an integral part of a more extensive lung procedure.If only a portion of the fibrous layer is removed, code 32225 (partial decortication) should be used.Thorough documentation is essential to ensure accurate coding and reimbursement.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Modifier TC rule: Not applicable
- Specialties:Cardiothoracic Surgery, Thoracic Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center