2025 CPT code 32491
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Respiratory System Surgery Feed
Removal of lung tissue, excluding total pneumonectomy, with resection or plication of emphysematous lung for lung volume reduction, via sternal split or transthoracic approach, including any pleural procedures.
Modifiers such as 50 (bilateral procedure) may be applicable, depending on the specific surgical approach and the extent of the resection.
Medical necessity for lung volume reduction surgery is established by the presence of severe emphysema, significant shortness of breath, impaired pulmonary function, and failure of less invasive treatment options.
Thoracic surgeon performs the procedure.Responsibilities include patient preparation, anesthesia administration (if not delegated), surgical access, dissection, resection and plication of the emphysematous lung tissue, hemostasis, wound closure and postoperative care.Anesthesia may be administered by a dedicated anesthesiologist or CRNA.
In simple words: The doctor removes diseased lung tissue to help someone breathe easier.They do this by making an incision either down the middle of the chest or in between the ribs, then remove the affected part of the lung. This often helps people who have a severe form of lung disease called emphysema.
This CPT code encompasses the surgical removal of diseased emphysematous lung tissue. Access to the lung is achieved through either a sternal split or transthoracic approach.The sternal split approach involves a midline incision through the chest and splitting of the sternum, allowing access to both lungs. The transthoracic approach uses an incision between the ribs to access the diseased lung.The procedure includes separating normal lung tissue from the diseased area, removing adhesions between the lung and chest wall using cautery, deflating the diseased lung, isolating and removing the emphysematous tissue via techniques like plication and blunt dissection, and closing the surgical wound.Temporary chest tubes may be placed for drainage.This procedure aims to reduce shortness of breath and improve quality of life.
Example 1: A 65-year-old male patient with severe bullous emphysema and significant shortness of breath undergoes a lung volume reduction surgery using a sternal split approach.32491 is reported.Significant portions of emphysematous tissue in both upper lobes are removed and plicated., A 70-year-old female patient with severe, primarily lower lobe, non-bullous emphysema undergoes a unilateral lung volume reduction surgery using a right transthoracic approach.32491 is reported.A significant volume of tissue is resected from the right lower lobe, and the remaining lung tissue is plicated., A 72 year old male with severe emphysema is undergoing a bilateral lung volume reduction surgery.Both upper lobes are affected.The patient is undergoing surgery through a sternal split approach.32491 is reported. Modifiers 50 (bilateral procedure) is applied.
* Comprehensive history and physical examination, including documentation of severe emphysema, shortness of breath, and other symptoms.* Pulmonary function tests (PFTs) demonstrating significant impairment.* Imaging studies (CT scan, chest X-ray) to visualize the extent of emphysema.* Exercise tolerance testing.* Arterial blood gas analysis.* Cardiac assessment to rule out contraindications.* Documentation of patient's smoking status (must be non-smoker for 4 months prior to surgery).* Operative report detailing the surgical technique, amount of lung tissue removed, and any complications.* Pathology report confirming the diagnosis of emphysema.
** The descriptor for 32491 explicitly states that it includes any pleural procedure when performed.Therefore, separate coding for pleural procedures is unnecessary. This code should not be used if a total pneumonectomy is performed.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: The RVUs for this code vary depending on the facility type (non-facility/facility) and geographic location. Consult your local Medicare fee schedule for specific RVU values and associated payment rates.
- Global Days: The global period for this procedure is dependent on the specific circumstances and should be determined using CMS guidelines. Consult the applicable Medicare Administrative Contractor (MAC) guidelines for the appropriate global period.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule data is not available in the provided data. Consult the CMS fee schedules for historical data.
- Specialties:Thoracic Surgery, Pulmonary Medicine
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center