CPT 32036 Thoracostomy Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 32036: Thoracostomy for Evacuation of Empyema with Skin Flap

CPT code 32036 represents a surgical thoracostomy performed to evacuate empyema with construction of a skin flap into the pleural space to prevent tract closure. Nationally, this code captures a definitive operative management approach for pleural space infections that require open drainage and tract maintenance. It is relevant to hospital surgical services, inpatient procedural coding, and severity-based reimbursement for thoracic surgery.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common billing considerations, standard sites of service, and the types of documentation and code capture typically associated with operative empyema management. The publication outlines national benchmarks where available, summarizes relevant policy and coverage considerations from major payers, and explains how this code fits within broader thoracic surgical service lines.

The content helps coding professionals, hospital billing teams, and clinical leaders understand the clinical intent of the code, operational settings where the procedure is performed, and payer coverage landscape. Data not provided in the input, such as associated taxonomies, specific ICD-10 diagnoses, and payer-specific reimbursement rates, is noted as unavailable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare32036CPTthoracostomyempyemathoracic surgerysurgical drainagehospital inpatientprocedure coding

Billing Code Overview

CPT code 32036 describes a thoracostomy to evacuate empyema with creation of a skin flap into the pleural space to prevent tract closure. The procedure involves surgically creating an artificial opening in the chest wall to remove purulent material (empyema) and fashioning a skin flap to maintain an open tract and reduce the likelihood of premature closure.

Service type: Surgical drainage and pleural cavity management

Typical site of service: Operating room or procedure suite, often within an inpatient hospital or surgical setting where thoracic procedures and management of pleural infections are performed.

Clinical & Coding Specifications

Clinical Context

A patient presents to the emergency department or surgical ward with signs of complicated pleural infection: persistent fever, pleuritic chest pain, dyspnea, leukocytosis, and imaging (chest radiograph or CT) demonstrating a loculated pleural effusion with suspected or proven empyema. Initial management includes antibiotics and image-guided thoracostomy or chest tube drainage. When drainage fails because of a chronic, organized empyema or the tract is prone to premature closure after simple tube removal, the thoracic surgeon performs a formal thoracostomy with creation of a skin flap into the pleural space (procedure 32036) to allow ongoing drainage and prevent tract closure.

The clinical workflow typically includes preoperative assessment and informed consent, perioperative antibiotics, general or regional anesthesia, incision and resection of skin and subcutaneous tissue, creation of a skin flap to stent the tract into the pleural cavity, debridement of infected pleural material, placement of dressings or packing for continued drainage, and scheduled wound care with potential definitive closure or surgical decortication later. Typical sites of service are the operating room, inpatient surgical ward, or occasionally the procedure room in acute care settings when performed at bedside for unstable patients.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

CPT 32225: Partial Decortication to Remove Pleural Fibrous Layer

CPT-32096-OPEN-PLEURAL-LUNG-BIOPSY

CPT 32096: Open Pleural/Lung Biopsy, Surgical Incision

CPT-32124-THORACOTOMY-PNEUMONOLYSIS

CPT 32124: Thoracotomy with Pneumonolysis

CPT-32098-OPEN-PLEURAL-BIOPSY

CPT 32098: Open Surgical Pleural Biopsy

CPT-32140-THORACOTOMY-PULMONARY-CYST-EXCISION

CPT 32140: Thoracotomy for Excision of Pulmonary Cyst(s)

CPT-32097-OPEN-SURGICAL-LUNG-MASS-BIOPSY-PLEURAL-SPACE

CPT 32097: Open Surgical Biopsy of Abnormal Lung Mass

CPT-32200-OPEN-DRAINAGE-PULMONARY-ABSCESS

CPT 32200: Open Drainage of Pulmonary Abscess or Cyst

CPT-32160-OPEN-CHEST-CARDIAC-MASSAGE-EMERGENCY-RESUSCITATION

CPT 32160: Open-Chest Cardiac Massage for Cardiac Arrest

CPT-32035-THORACOSTOMY-RIB-EXCISION-EMPYEMA

CPT 32035: Thoracostomy and Rib Excision for Empyema

CPT-32215-SURGICAL-PLEURAL-ADHESION-ABRASION-FOR-RECURRENT-PNEUMOTHORAX

CPT 32215: Surgical Abrasion for Recurrent Pneumothorax

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Taxonomy Code	Specialty	Notes
`340600000X`	Thoracic Surgery	Primary specialty performing `32036` for empyema management and chronic pleural space problems.
`208000000X`	General Surgery	Frequently performs thoracostomy procedures in acute or resource-limited settings.
`207R00000X`	Pulmonary Disease	May be involved in diagnosis and postoperative management but rarely performs this surgical procedure.
`163W00000X`	Critical Care Medicine	Participates in perioperative management of critically ill patients undergoing thoracostomy.
`367A00000X`	Physician Assistant	Common operative assistant in the surgical team for thoracostomy procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J86.9`	Pyothorax without fistula, unspecified	Represents pleural space infection (empyema) that commonly necessitates thoracostomy for drainage.
`J86.0`	Pyothorax with fistula	Empyema with cutaneous fistula or bronchopleural fistula may require skin-flap thoracostomy to manage ongoing drainage.
`J90`	Pleural effusion, not elsewhere classified	Large or complicated effusions that become infected can progress to empyema requiring `32036`.
`J94.8`	Other pleural conditions, not elsewhere classified	Includes chronic pleural space problems and loculations that may need surgical drainage.
`J85.1`	Abscess of lung with bronchopleural fistula	Complicated intrapulmonary infection communicating with pleural space, often associated with empyema management.
`B95.3`	Streptococcus, group B, as the cause of diseases classified elsewhere	Example organism code to identify causative pathogen when empyema is culture-positive (used as an add-on when appropriate).

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32035`	Removal of empyema by simple thoracostomy; without creation of a skin flap	Less extensive alternative; often attempted prior to `32036` when simple drainage suffices.
`32100`	Thoracostomy, with implantation of intrapleural catheter for drainage	Alternative drainage technique for ongoing pleural drainage; may be used instead of formal skin-flap thoracostomy.
`32554`	Thoracoscopy, with drainage and decortication of empyema, with or without chest tube placement	Definitive surgical management that may follow or replace thoracostomy when debridement and lung re-expansion are necessary.
`32421`	Thoracotomy with decortication of lung; for empyema (open procedure)	More extensive open procedure for chronic empyema; may be performed if thoracostomy and drainage are insufficient.
`10120`	Incision and drainage of hematoma, seroma, or fluid collection	Minor incision/drainage procedures that can be performed for superficial collections related to thoracostomy site care.

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