CPT 32141 Thoracotomy Bullectomy Reimbursement

CPT code 32141 represents a thoracotomy performed to remove or fold over pulmonary bullae, sometimes including pleural procedures. This operative code captures a clinically significant thoracic surgical intervention used to treat bullous lung disease and recurrent spontaneous pneumothorax caused by large air-filled spaces. Nationally, accurate coding for 32141 matters for surgical quality measurement, hospital case mix, and appropriate tracking of thoracic surgical volumes and outcomes. Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, payer coverage considerations, and benchmarking and policy-oriented content relevant to billing and claims processing. The publication outlines typical sites of service and service type, common modifiers and coding considerations (when available), and how 32141 relates to related thoracic procedures. It provides guidance on documentation elements that support the code selection and highlights areas where policy or reimbursement updates commonly affect claim adjudication. Data not available in the input is explicitly noted where applicable.

Billing Code Overview

CPT code 32141 describes a thoracotomy with bullectomy or bulla plication. The procedure involves a surgical incision into the chest to remove or fold over pulmonary bullae. The provider may also perform a procedure on the pleura (the membrane surrounding the lungs) as part of the operation.

Service type: Surgical, thoracic surgery
Typical site of service: Hospital operating room or inpatient surgical suite

Clinical Context

A 48-year-old patient with a history of spontaneous pneumothorax and symptomatic giant pulmonary bullae presents with progressive dyspnea and recurrent episodes of pleuritic chest pain. Imaging with chest radiograph and chest CT confirms large apical bullae occupying a significant portion of the upper lobe, with surrounding compression of adjacent lung parenchyma. After multidisciplinary evaluation, the thoracic surgeon schedules an open thoracotomy for bullectomy (resection or stapled excision of the bullae) to remove/obliterate the offending air space and allow lung re-expansion. The clinical workflow includes preoperative assessment (cardiopulmonary evaluation, informed consent, anesthesia evaluation), intraoperative open thoracotomy with bullectomy (and optional pleurodesis or pleural decortication if indicated), immediate postoperative chest tube management, inpatient monitoring of respiratory status and pain control, chest physiotherapy, and follow-up imaging to confirm lung re-expansion and absence of air leak.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (status not otherwise indicated)	Use when no specific modifier applies and the service is billed in standard fashion.
`11`	Decision for surgery was made and surgery performed

Taxonomy Code	Specialty	Notes
207L00000X	Thoracic Surgery	Thoracic surgeons most commonly perform open thoracotomy and bullectomy procedures.
207K00000X	Cardiothoracic Surgery	Cardiothoracic surgeons perform thoracotomy and lung resection operations, including bullectomy.
2080P0005X	General Surgery	General surgeons with thoracic experience may perform thoracotomy in some settings.
2084P0800X	Pulmonary Disease (consultant)	Pulmonologists provide preoperative and postoperative management and diagnostic evaluation.
208M00000X	Anesthesiology	Anesthesiologists provide perioperative anesthesia and pain management for thoracotomy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J98.11`	Primary spontaneous pneumothorax	Common indication when bullae rupture leading to pneumothorax; bullectomy may be performed to prevent recurrence.
`J98.2`	Interstitial emphysema	Bullous disease and airspace abnormalities that may coexist with giant bullae; may necessitate surgical management.
`J43.9`	Emphysema, unspecified	Bullous emphysema with large bullae is a frequent underlying diagnosis prompting bullectomy.
`J98.4`	Bronchopleural fistula	A complication of ruptured bullae or lung disease that may be addressed during thoracotomy.
`R09.2`	Pleural effusion, unspecified	Pleural fluid may accompany bullous disease or necessitate pleural procedures during thoracotomy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31620`	Bronchoscopy, rigid or flexible, diagnostic (separate procedure)	Diagnostic airway evaluation and airway toileting may be performed preoperatively or intraoperatively to assess bronchial anatomy and clear secretions.
`32551`	Tube thoracostomy, includes water-seal drainage and connection to suction, when performed	Chest tube placement is commonly performed intraoperatively or postoperatively for pleural drainage after thoracotomy and bullectomy.
`32666`	Thoracoscopy, surgical; with bullectomy resection of giant bulla(s)	Minimally invasive alternative (video-assisted thoracoscopic surgery) for bullectomy; may be an alternative or adjunct to open thoracotomy.
`32557`	Decortication, pleura, thoracotomy	If dense pleural peel or empyema is present, pleural decortication may be performed at the same operation.
`32661`	Thoracotomy, with pulmonary wedge resection	Performed when a small wedge resection is needed in addition to bullectomy for pathological tissue removal.

OpenPayer

Summary & Overview

CPT 32141: Thoracotomy for Bullectomy or Bulla Plication