2014 Thoracic Reimbursement Fact Sheet
The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Ethicon concerning levels of reimbursement, payment, or charge. Similarly, all CPT, ICD-9 and HCPCS codes
are supplied for informational purposes only and represent no statement, promise, or guarantee by Ethicon that these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payor.
CPT codes and descriptions are copyright 2014 American Medical Association. ICD-9 codes and descriptions are copyright 2014 World Health Organization’s Ninth Revision, International Classification of Diseases. HCPCS Level II codes and descriptions are
copyright 2014 the Centers for Medicare and Medicaid Services Healthcare Common Procedure Coding System. While we have made an effort to provide information that is current at the time of its issue, the information may not be as current or comprehensive when you view it. We strongly recommend that you consult your counsel, reimbursement specialist or payor organization with regard to reimbursement policies. Physicians should refer to their provider Carrier Manual for their geographic payments.
SURGEON
CPT CODE1
PROCEDURE
32480
32482
32663
32670
Lobectomy Procedures
Open Procedures
Removal of lung, other than pneumonectomy; single lobe (lobectomy)
Removal of lung, other than pneumonectomy; two lobes (bilobectomy)
Thorascopic (VATS) Procedures
Thoracoscopy, surgical; with lobectomy (single lobe)
Thoracoscopy, surgical; with removal of 2 lobes (bilobectomy)
32505
+32506
+32507
32666
+32667
+32668
Wedge Resection Procedures
Open Procedures
Thoracotomy; with therapeutic wedge resection (eg, mass, nodule), initial
Thoracotomy; with therapeutic wedge resection (eg, mass, nodule), each additional resection, ipsilateral (List separately in addition to code for primary procedure)
Thoracotomy; with diagnostic wedge resection followed by anatomic lung resection (List separately in addition to code for primary procedure)
Thorascopic (VATS) Procedures
Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass, nodule), initial unilateral
Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass or nodule), each additional resection, ipsilateral
(List separately in addition to code for primary procedure)
Thoracoscopy, surgical; with diagnostic wedge resection followed by anatomic lung resection
(List separately in addition to code for primary procedure)
43107
43108
43112
43113
43116
43117
43118
43121
43122
43123
43124
32665
Esophagectomy Procedures
Open Procedures
Total or near total esophagectomy, without thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy,
with or without pyloroplasty (transhiatal)
Total or near total esophagectomy, without thoracotomy; with colon interposition or small intestine reconstruction, including intestine
mobilization, preparation and anastomosis(es)
Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty
Total or near total esophagectomy, with thoracotomy; with colon interposition or small intestine reconstruction, including intestine
mobilization, preparation, and anastomosis(es)
Partial esophagectomy, cervical, with free intestinal graft, including microvascular anastomosis, obtaining the graft and intestinal reconstruction
Partial esophagectomy, distal 2/3, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with thoracic
esophagogastrostomy, with or without pyloroplasty (Ivor Lewis)
Partial esophagectomy, distal 2/3, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with colon interposition
or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)
Partial esophagectomy, distal 2/3, with thoracotomy only, with or without proximal gastrectomy, with thoracic esophagogastrostomy,
with or without pyloroplasty
Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with esophagogastrostomy,
with or without pyloroplasty
Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with colon interposition or small intestine
reconstruction, including intestine mobilization, preparation, and anastomosis(es)
Total or partial esophagectomy, without reconstruction (any approach), with cervical esophagostomy
Thorascopic (VATS) Procedures
Thoracoscopy, surgical; with esophagomyotomy (Heller type)
NATIONAL AVERAGE MEDICARE PAYMENT2
$1,534
1,643
$1,452
1,658
$964
164
164
$902
164
164
NOTE: + signifies an add-on code, a procedure that is in addition to another, or primary, procedure being performed.
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$2,625
4,793
2,778
4,686
5,422
2,549
3,728
2,969
2,638
4,857
3,958
$1,263
32440
32442
32445
32671
Pneumonectomy Procedures
Open Procedures
Removal of lung, pneumonectomy
Removal of lung, pneumonectomy; with resection of segment of trachea followed by broncho tracheal anastomosis (sleeve pneumonectomy)
Removal of lung, pneumonectomy; extrapleural
Thorascopic (VATS) Procedures
Thoracoscopy, surgical; with removal of lung (pneumonectomy)
$1,624
3,333
3,667
32484
32488
32669
Segmentectomy Procedures
Open Procedures
Removal of lung, other than Pneumonectomy; single segment (segmentectomy)
Removal of lung, other than pneumonectomy; with all remaining lung following previous removal of a portion of lung (completion pneumonectomy)
Thorascopic (VATS) Procedures
Thoracoscopy, surgical; with removal of a single lung segment (segmentectomy)
$1,488
2,491
32491
32672
Lung Volume Reduction (LVRS) Procedures
Open Procedures
Removal of lung, other than pneumonectomy; with resection-plication of emphysematous lung(s)
(bulbous or non bullous) for lung volume reduction, sternal split or transthoracic approach, includes any pleural procedure when performed Thorascopic (VATS) Procedures
Thoracoscopy, surgical; with resection-plication for emphysematous lung (bullous or non-bullous) for lung volume
reduction (LVRS), unilateral includes any pleural procedure, when performed
$1,525
32096
32097
32098
32110
32120
32124
32140
32141
32486
+32501
Miscellaneous Procedures
Open Procedures
Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral
Thoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral
Thoracotomy, with biopsy(ies) of pleura
Thoracotomy; with control of traumatic hemorrhage and/or repair of lung tear
Thoracotomy; for postoperative complications
Thoracotomy; with open intrapleural pneumonolysis
Thoracotomy; with cyst(s) removal, includes pleural procedure when performed
Thoracotomy; with resection-plication of bullae, includes any pleural procedure when performed
Removal of lung, other than pneumonectomy; with circumferential resection of segment of bronchus followed by
broncho-bronchial anastomosis (sleeve lobectomy)
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)
NOTE: + signifies an add-on code, a procedure that is in addition to another, or primary, procedure being performed.
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$1,847
$1,395
$1,584
$835
836
789
1,507
903
962
1,027
1,588
2,437
255
Miscellaneous Procedures Continued
32601
32604
32606
32607
32608
32609
32650
32651
32652
32653
32654
32655
32656
32658
32659
32661
32662
32664
32673
+32674
Thorascopic (VATS) Procedures
Thoracoscopy, diagnostic (separate procedure); lungs, pericardial sac, mediastinal or pleural space, without biopsy
Thoracoscopy, diagnostic (separate procedure); pericardial sac, with biopsy
Thoracoscopy, diagnostic (separate procedure); mediastinal space, with biopsy
Thoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral
Thoracoscopy; with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral
Thoracoscopy; with biopsy(ies) of pleura
Thoracoscopy, surgical; with pleurodesis (eg, mechanical or chemical)
Thoracoscopy, surgical; with partial pulmonary decortication
Thoracoscopy, surgical; with total pulmonary decortication, including intrapleural pneumonolysis
Thoracoscopy, surgical; with removal of intrapleural foreign body or fibrin deposit
Thoracoscopy, surgical; with control of traumatic hemorrhage
Thoracoscopy, surgical; with resection-plication of bullae, includes any pleural procedure when performed
Thoracoscopy, surgical; with parietal pleurectomy
Thoracoscopy, surgical; with removal of clot or foreign body from pericardial sac
Thoracoscopy, surgical; with creation of pericardial window or partial resection of pericardial sac for drainage
Thoracoscopy, surgical; with excision of pericardial cyst, tumor, or mass
Thoracoscopy, surgical; with excision of mediastinal cyst, tumor, or mass
Thoracoscopy, surgical; with thoracic sympathectomy
Thoracoscopy, surgical; with resection of thymus, unilateral or bilateral
Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy
(List separately in addition to code for primary procedure)
$321
499
480
321
394
272
689
1,132
1,720
1,095
1,216
989
826
739
757
827
926
879
1,251
224
NOTE: + signifies an add-on code, a procedure that is in addition to another, or primary, procedure being performed.
OUTPATIENT FACILITY
Hospital Outpatient Department
APC DESCRIPTION
Thoracoscopy (CPT Codes: 32601, 32604, 32606, 32607, 32608, 32609)
APC
0069
MEDICARE PAYMENT3
$2,640
INPATIENT FACILITY
ICD-9 CODE DESCRIPTION
ICD-9 CODE5DESCRIPTION
05.29
07.83
07.84
32.20
32.21
32.22
32.23
32.25
32.26
32.28
32.29
32.30
32.41
32.49
32.50
32.59
32.9
33.1
33.20
33.39
Other sympathectomy and ganglionectomy
Thoracoscopic partial excision of thymus
Thoracoscopic total excision of thymus
Thoracoscopic excision of lesion or tissue of lung
Plication of emphysematous bleb
Lung volume reduction surgery
Open ablation of lung lesion or tissue
Thoracoscopic ablation of lung lesion or tissue
Other and unspecified ablation of lung lesion or tissue
Endoscopic excision or destruction of lesion or tissue of lung
Other local excision or destruction of lesion or tissue of lung
Thoracoscopic segmental resection of lung
Thoracoscopic lobectomy of lung
Other lobectomy of lung
Thoracoscopic pneumonectomy
Other and unspecified pneumonectomy
Other excision of lung
Incision of lung
Thoracoscopic lung biopsy
Other surgical collapse of lung
33.43
Closure of laceration of lung
33.49
Other repair and plastic operations on lung
33.99
Other operations on lung
34.02
Exploratory thoracotomy
34.03
Reopening of recent thoracotomy site
34.09
Other incision of pleura
34.21
Transpleural thoracoscopy
34.22Mediastinoscopy
34.24
Other pleural biopsy
34.25
Closed [percutaneous] [needle] biopsy of mediastinum
34.3
Excision or destruction of lesion or tissue of mediastinum
34.51
Decortication of lung
34.59
Other excision of pleura
34.6
Scarification of pleura
34.92
Injection into thoracic cavity
40.3
Regional lymph node excision
40.52
Radical excision of periaortic lymph nodes
40.59
Radical excision of other lymph nodes
42.7Esophagomyotomy
5
NOTE: ICD-9 codes are grouped into Medicare Severity Diagnoses Related Groups (MS-DRGs) for Medicare reimbursement using a patient’s diagnoses, procedures performed, age, sex and discharge status.
One MS-DRG is assigned to each inpatient stay.
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INPATIENT FACILITY
DRG
163
164
165
166
167
168
DESCRIPTION*
Major chest procedures with MCC
Major chest procedures with CC
Major chest procedures without CC/MCC
Other Respiratory System O.R. Procedures with MCC
Other Respiratory System O.R. Procedures with CC
Other Respiratory System O.R. Procedures without CC/MCC
AVERAGE LENGTH OF STAY (DAYS)6
13.4
6.7
4.0
11.2
6.6
3.9
NATIONAL AVERAGE DRG PAYMENT6
$29,550
15,129
10,406
21,308
11,518
7,598
* CC stands for Complications and Comorbidities while MCC refers to Major Complications and Comorbidities. These are a measure of the severity of an illness indicating additional diagnoses present
on a case that MAY increase the expected resource consumption beyond that of the same case without a CC or MCC under the current Medicare definition. Whether a complication or comorbiditiy is
classified as a CC or MCC is defined by Medicare.
1All Current Procedural Terminology (CPT) five-digit numeric codes, descriptions, numeric modifiers, instructions, guidelines and other material are copyright 2014 American Medical Association. All Rights Reserved.
2Federal Register, Vol. 78, No. 237, Tuesday, December 10, 2013/Rules and Regulations. The 2014 Final Physician Reimbursement Conversion Factor = $35.8228.
3Federal Register, Vol. 78, No. 237, Tuesday, December 10, 2013/Rules and Regulations; Final Hospital Outpatient Payment.
4Federal Register, Vol. 78, No. 237, Tuesday, December 10, 2013/Rules and Regulations; Final ASC Reimbursement.
5Hospital ICD-9-CM 2010 Volumes 1, 2 & 3, 9th Revision-Clinical Modification, American Medical Association. Copyright © 2014 Saunders, an imprint of Elsevier, Inc.
6Federal Register, Vol. 78, No. 160, Monday, August 19, 2013/ Rules and Regulations; Final National Average DRG Payment.
Ethicon Reimbursement Support Program - (888) 750-1242 www.ethicon.com
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