2014 Thoracic
Medicare Reimbursement Coding Guide
Effective January 1, 2014
Medicare National Average Rates and Allowables
(Not Adjusted For Geography)
PHYSICIAN
CPT™*
HCPCS
Code
Procedure Description
*
MPFS
(CF=$35.8228)
Fac/Non-Fac
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUPATIENT
APC
Classification
APC
Descriptor
APC
Rate
**
ASC
***
DIAGNOSTIC
32096
Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s)
(eg, wedge, incisional), unilateral
$835.39
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32097
Thoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or
mass(es) (eg, wedge, incisional), unilateral
$835.75
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32098
Thoracotomy, with biopsy(ies) of pleura
$788.82
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32100
Thoracotomy; with exploration
$844.70
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32400
Biopsy, pleura; percutaneous needle
$90.63 / $153.68
0685
Level III
Needle Biopsy/
Aspiration
Except Bone
Marrow
$757.76
$418.60
0685
Level III
Needle Biopsy/
Aspiration
Except Bone
Marrow
$757.76
$418.60
32405
Biopsy, lung or mediastinum, percutaneous needle
$107.47 /
$452.08
32601
Thoracoscopy, diagnostic (separate procedure); lungs,
pericardial sac, mediastinal or pleural space, without biopsy
$320.61
0069
Thoracoscopy
$2,640.12
Not reimbursed
in ASC by
Medicare
32604
Thoracoscopy, diagnostic (separate procedure); pericardial sac,
with biopsy
$499.37
0069
Thoracoscopy
$2,640.12
Not reimbursed
in ASC by
Medicare
32606
Thoracoscopy, diagnostic (separate procedure); mediastinal
space, with biopsy
$479.67
0069
Thoracoscopy
$2,640.12
Not reimbursed
in ASC by
Medicare
32607
Thoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s)
(eg, wedge, incisional), unilateral
$320.97
0069
Thoracoscopy
$2,640.12
Not reimbursed
in ASC by
Medicare
32608
Thoracoscopy; with diagnostic biopsy(ies) of lung nodule(s) or
mass(es) (eg, wedge, incisional), unilateral
$394.05
0069
Thoracoscopy
$2,640.12
Not reimbursed
in ASC by
Medicare
32609
Thoracoscopy; with biopsy(ies) of pleura
$271.90
0069
Thoracoscopy
$2,640.12
Not reimbursed
in ASC by
Medicare
PHYSICIAN
CPT™*
HCPCS
Code
Procedure Description
*
MPFS
(CF=$35.8228)
Fac/Non-Fac
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUPATIENT
APC
Classification
APC
Descriptor
APC
Rate
**
ASC
***
EXCISION
32110
Thoracotomy; with control of traumatic hemorrhage and/or
repair of lung tear
32120
Thoracotomy; for postoperative complications
32140
$1,507.07
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
$902.73
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Thoracotomy; with cyst(s) removal, includes pleural procedure
when performed
$1,027.40
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32141
Thoracotomy; with resection-plication of bullae, includes any
pleural procedure when performed
$1,587.67
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32150
Thoracotomy; with removal of intrapleural foreign body or
fibrin deposit
$1,040.29
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32151
Thoracotomy; with removal of intrapulmonary foreign body
$1,037.07
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32160
Thoracotomy; with cardiac massage
$814.61
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32440
Removal of lung, pneumonectomy;
$1,623.85
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32442
Removal of lung, pneumonectomy; with resection of segment
of trachea followed by broncho-tracheal anastomosis (sleeve
pneumonectomy)
$3,332.95
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32445
Removal of lung, pneumonectomy; extrapleural
$3,667.18
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32480
Removal of lung, other than pneumonectomy; single lobe
(lobectomy)
$1,533.93
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32482
Removal of lung, other than pneumonectomy; 2 lobes
(bilobectomy)
$1,642.83
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32484
Removal of lung, other than pneumonectomy; single segment
(segmentectomy)
$1,488.08
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32486
Removal of lung, other than pneumonectomy; with
circumferential resection of segment of bronchus followed by
broncho-bronchial anastomosis (sleeve lobectomy)
$2,437.38
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32488
Removal of lung, other than pneumonectomy; with all
remaining lung following previous removal of a portion of lung
(completion pneumonectomy)
$2,491.12
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32491
Removal of lung, other than pneumonectomy; with resectionplication of emphysematous lung(s) (bullous or non-bullous)
for lung volume reduction, sternal split or transthoracic
approach, includes any pleural procedure, when performed
$1,524.62
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+325011
Resection and repair of portion of bronchus (bronchoplasty)
when performed at time of lobectomy or segmentectomy (List
separately in addition to code for primary procedure)
$254.70
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32650
Thoracoscopy, surgical; with pleurodesis (eg, mechanical or
chemical)
$688.87
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32651
Thoracoscopy, surgical; with partial pulmonary decortication
$1,132.36
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32652
Thoracoscopy, surgical; with total pulmonary decortication,
including intrapleural pneumonolysis
$1,720.21
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32653
Thoracoscopy, surgical; with removal of intrapleural foreign
body or fibrin deposit
$1,094.74
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32654
Thoracoscopy, surgical; with control of traumatic hemorrhage
$1,215.83
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32655
Thoracoscopy, surgical; with resection-plication of bullae,
includes any pleural procedure when performed
$989.43
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32656
Thoracoscopy, surgical; with parietal pleurectomy
$826.07
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32658
Thoracoscopy, surgical; with removal of clot or foreign body
from pericardial sac
$739.02
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32659
Thoracoscopy, surgical; with creation of pericardial window or
partial resection of pericardial sac for drainage
$756.94
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32661
Thoracoscopy, surgical; with excision of pericardial cyst, tumor,
or mass
$826.79
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32662
Thoracoscopy, surgical; with excision of mediastinal cyst, tumor,
or mass
$926.02
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
PHYSICIAN
CPT™*
HCPCS
Code
Procedure Description
*
MPFS
(CF=$35.8228)
Fac/Non-Fac
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUPATIENT
APC
Classification
APC
Descriptor
APC
Rate
**
ASC
***
32663
Thoracoscopy, surgical; with lobectomy (single lobe)
$1,452.26
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32664
Thoracoscopy, surgical; with thoracic sympathectomy
$878.73
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32665
Thoracoscopy, surgical; with esophagomyotomy (Heller type)
$1,263.11
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32666
Thoracoscopy, surgical; with therapeutic wedge resection (eg,
mass, nodule), initial unilateral
$901.66
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+326672
Thoracoscopy, surgical; with therapeutic wedge resection (eg,
mass or nodule), each additional resection, ipsilateral (List
separately in addition to code for primary procedure)
$164.07
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+326683
Thoracoscopy, surgical; with diagnostic wedge resection
followed by anatomic lung resection (List separately in addition
to code for primary procedure)
$164.07
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
$976.89
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
$803.86
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
HERNIA
32800
Repair lung hernia through chest wall
PLEURAL
32036
Thoracostomy; with open flap drainage for empyema
32124
Thoracotomy; with open intrapleural pneumonolysis
32200
Pneumonostomy, with open drainage of abscess or cyst
$961.84
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
$1,173.91
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32215
Pleural scarification for repeat pneumothorax
$828.22
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32220
Decortication, pulmonary (separate procedure); total
$1,643.55
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32225
Decortication, pulmonary (separate procedure); partial
$1,030.62
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32310
Pleurectomy, parietal (separate procedure)
$950.74
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32320
Decortication and parietal pleurectomy
$1,655.01
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32505
Thoracotomy; with therapeutic wedge resection (eg, mass,
nodule), initial
$964.35
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+325064
Thoracotomy; with therapeutic wedge resection (eg, mass or
nodule), each additional resection, ipsilateral (List separately in
addition to code for primary procedure)
$163.71
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+325075
Thoracotomy; with diagnostic wedge resection followed by
anatomic lung resection (List separately in addition to code for
primary procedure)
$163.71
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32540
Extrapleural enucleation of empyema (empyemectomy)
$1,800.10
49405
Image-guided fluid collection drainage by catheter (eg, abscess,
hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver,
spleen, lung/mediastinum), percutaneous
$220.31 /
$886.26
+
0037
Level IV
Needle Biopsy/
Aspiration
Except Bone
Marrow
$1,223.25
Not reimbursed
in ASC by
Medicare
NOTES:
1
Use 32501 in conjunction with 32480, 32482, 32484.
2
Report 32667 only in conjunction with 32666.
3
Report 32668 in conjunction with 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32503, 32504, 32663, 32669, 32670, 32671.
4
Report 32506 only in conjunction with 32505.
5
Report 32507 in conjunction with 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32503, 32504.
Multiple Procedure Discounting – Multiple surgical procedures furnished during the same operative session are discounted.
50% is paid for any other surgical procedure(s) performed at the same time.
The above National Average APC and ASC (Freestanding) Rates represent the reimbursement amounts paid directly to the facility for the technical portion of the procedure. The Physician (surgeon) would separately receive the professional
fee (MPFS Allowable) for the procedure performed.
+
CY 2014 CPT Code Manual parenthetical instruction: CPT 32201 (Pneumonostomy; with percutaneous drainage of abscess or cyst) has been deleted CY 2014. For percutaneous image-guided draining of abscess or cyst of lungs or
mediastinum by catheter placement, use CPT 49405 (Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous); new code added
for CY 2014.
TABLE REFERENCES:
*PFS Relative Value File, RVU14A (12-19-13), effective January 1, 2014
**January 2014 HOPPS Addenda A and B (12-19-13), effective January 1, 2014
***January 2014 ASC Addendum AA, BB, DD1, DD2, and EE (1-2-14), effective January 1, 2014
ICD-9-CM Volume 3 Hospital Procedure Codes
Procedure Code*
Description
32.20
Thoracoscopic excision of lesion or tissue of lung
32.21
Plication of emphysematous bleb
32.22
Lung volume reduction surgery
32.29
Other local excision or destruction of lesion or tissue of lung
32.30
Thoracoscopic segmental resection of lung
32.39
Other and unspecified segmental resection of lung
32.41
Thoracoscopic lobectomy of lung
32.49
Other lobectomy of lung
32.50
Thoracoscopic pneumonectomy
32.59
Other and unspecified pneumonectomy
32.6
Radical dissection of thoracic structures
32.9
Other excision of lung
33.20
Thoracoscopic lung biopsy
33.24
Closed [endoscopic] biopsy of bronchus
33.25
Open biopsy of bronchus
33.26
Closed [percutaneous] [needle] biopsy of lung
33.27
Closed endoscopic biopsy of lung
33.28
Open biopsy of lung
33.29
Other diagnostic procedures on lung or bronchus
34.06
Thoracoscopic drainage of pleural cavity
34.20
Thoracoscopic pleural biopsy
34.21
Transpleural thoracoscopy
34.22
Mediastinoscopy
34.23
Biopsy of chest wall
34.24
Other pleural biopsy
34.25
Closed [percutaneous] [needle] biopsy of mediastinum
34.26
Open mediastinal biopsy
34.27
Biopsy of diaphragm
34.28
Other diagnostic procedures on chest wall, pleura, and diaphragm
34.29
Other diagnostic procedures on mediastinum
34.3
Excision or destruction of lesion or tissue of mediastinum
34.4
Excision or destruction of lesion of chest wall
34.51
Decortication of lung
34.52
Thoracoscopic decortication of lung
34.59
Other excision of pleura
NOTES:
The ICD-9-CM Hospital Procedure Codes listed above may be used in the MS-DRG Classifications (See Inpatient DRG Payment Rates Table)
The appropriate MS-DRG classification is also dependent on the diagnosis code, demographics, sex and possible co-conditions.
TABLE REFERENCES:
*
2014 Hospital ICD-9-CM Volume 3, 9th Revision, Clinical Modification, Sixth Edition
Inpatient DRG Payment Rates
MS-DRG*
MS-DRG Title
Arithmetic Mean Length
of Stay (Days)
National Average
Payment**
163
Major Chest Procedures w MCC
13.4
$29,550.07
164
Major Chest Procedures w CC
6.7
$15,128.81
165
Major Chest Procedures w/o CC/MCC
4.0
$10,406.20
166
Other Resp System O.R. Procedures w MCC
11.2
$21,308.27
167
Other Resp System O.R. Procedures w CC
6.6
$11,517.99
168
Other Resp System O.R. Procedures w/o CC/MCC
3.9
$7,598.04
MS-DRG*
MS-DRG Title
Arithmetic Mean Length
of Stay (Days)
National Average
Payment**
820
Lymphoma & Leukemia w Major O.R. Procedure w MCC
17.1
$34,089.41
821
Lymphoma & Leukemia w Major O.R. Procedure w CC
6.9
$13,933.51
822
Lymphoma & Leukemia w Major O.R. Procedure w/o CC/MCC
2.8
$7,154.37
981
Extensive O.R. Procedure Unrelated to Principal Diagnosis w MCC
13.1
$28,603.00
982
Extensive O.R. Procedure Unrelated to Principal Diagnosis w CC
7.6
$16,531.15
983
Extensive O.R. Procedure Unrelated to Principal Diagnosis w/o CC/MCC
3.8
$10,127.24
NOTE:
*
One DRG per patient is assigned to each inpatient stay.
TABLE REFERENCES:
**
FY 2014 Final Rule, Federal Register, Vol. 78, No. 160, Monday, August 19, 2013, Table 1A-1E. National Average Payment Rate is based upon
the National Average Operating Standardized Amount ($5,370.28) plus the Capital Standard Federal Payment Rate ($429.31).
ICD-9-CM Diagnosis Codes
Dx Code**
Description
162.x*
Malignant neoplasm of trachea, bronchus, and lung
197.0
Secondary malignant neoplasm of lung
235.7
Neoplasm of uncertain behavior of trachea, bronchus, and lung
239.1
Neoplasm of unspecified nature of respiratory system
492.x*
Emphysema
510.x
Empyema
*
511.x*
Pleurisy
512.xx
Pneumothorax and air leak
518.xx*
Other diseases of lung
786.xx
Symptoms involving respiratory system and other chest symptoms
793.11
Solitary pulmonary nodule
793.19
Other nonspecific abnormal finding of lung field
*
*
NOTES:
*
Check 4th or 5th digit.
TABLE REFERENCES:
**
2014 Hospital ICD-9-CM Volume 1 and 2, 9th Revision, Clinical Modification, Sixth Edition
Disclaimer:
The information contained in this guide is provided to help you understand the reimbursement process. It is not intended to increase or maximize reimbursement by any
payer. We strongly recommend that providers consult their payer organization with regard to local reimbursement policies. The information contained in this guide is
provided for information purposes only and represents no statement, promise or guarantee by Covidien concerning levels of reimbursement, payment or charge.
Similarly, all CPT HCPCS and ICD-9-CM codes are supplied for information purposes only and represent no statement, promise or guarantee by Covidien that these
codes will be appropriate or that reimbursement will be made. ICD-9-CM is based on the official version of the World Health Organization’s Ninth Revision, International
Classification of Diseases. CPT codes and descriptions only are copyright 2013 American Medical Association. All rights reserved.
CPT does not include fee schedules, relative values or related listings. The source for this information is the Centers for Medicare and Medicaid Services (CMS).
Reimbursement rates reflected in this guide are Medicare National Average rates as published by CMS at the time of printing, and do not reflect provider payment
adjustment factors such geographic adjustment, participation as a Disproportionate Share or Teaching Hospital, participation in the CMS Shared Service (ACO) program,
or Value Base Purchasing adjustments. The content provided by CMS is updated frequently. It is the responsibility of the health services provider to confirm the appropriate
coding required by their local Medicare Administrative Contractors (MACs), carriers, fiscal intermediaries and commercial payers.
All Current Procedural Terminology (CPT) five-digit numeric codes, descriptions, numeric modifiers, instructions, guidelines and other material are copyright © 2013
American Medical Association. All rights reserved.
Code associations and values have been reviewed and validated by NMD Healthcare, Inc.
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