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    OpenPayerBilling CodesIncision Procedures on the Lungs and PleuraCPT cpt-32220-total-decortication-pleural-rind-removal
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    CPT 32220: Total Decortication (Removal of Fibrous Pleural Peel)

    Medicare pays $1553 on average nationally for this procedure.

    CPT code 32220 describes surgical total decortication, the removal of the fibrous layer (peel) restricting lung expansion, performed to restore lung re-expansion; this is a thoracic surgical procedure typically done in an operating room or inpatient surgical suite for patients with trapped lung from empyema or organized pleural peel.

    For related coverage guidance, see recent payer policy updates: Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA), Cardiovascular Disease Risk Assessment, Biomarkers for Myocardial Infarction and Chronic Heart Failure.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old patient presents with chronic pleural thickening and a trapped lung following an organized empyema that is causing progressive dyspnea, restricted chest wall expansion, and recurrent pleural effusion despite prior tube thoracostomy and antibiotics. Imaging (chest CT and chest X-ray) demonstrates a dense fibrous rind encasing the lung with failure of lung re-expansion. The thoracic surgeon schedules a surgical decortication under general anesthesia. The operative workflow includes preoperative evaluation, general endotracheal anesthesia, possible single-lung ventilation, thoracotomy or video-assisted thoracoscopic surgery (VATS) to access the pleural space, meticulous peeling and removal of the visceral and parietal fibrous peel to restore lung expansion (total decortication), hemostasis, placement of chest drains, and postoperative monitoring in a PACU or inpatient setting. Typical perioperative documentation captures the indication (e.g., trapped lung due to organized empyema), procedure performed as total decortication (32220), laterality, anesthesia type, estimated blood loss, implantable devices (chest tubes), and postoperative condition. Typical sites of service are the hospital inpatient operating room or ambulatory surgical center when clinically appropriate and safe for the patient.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    32421Video-assisted thoracoscopic surgery (VATS), surgical; with pleurectomy/decorticationMinimally invasive approach alternative or adjunct to open total decortication; may be used when VATS technique is employed.
    32551Tube thoracostomy, includes drainage of pleural spaceOften performed prior to or in conjunction with management of empyema and may precede decortication.
    31830Bronchoscopy, rigid or flexible, diagnostic; with bronchial or tracheal dilation (if documented)May be performed preoperatively to evaluate airway or secretions; diagnostic bronchoscopy can be part of the workup.
    31500Intubation, endotracheal, emergency proceduresAirway management code related to anesthesia and perioperative airway control (documentation dependent).
    15734Muscle or musculocutaneous flap with microvascular anastomosis (for chest wall reconstruction)Rarely related; may be performed when chest wall reconstruction is required after extensive debridement or resection.

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    24Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    363LP0808XPsychiatric/Mental Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    3336M0003XManaged Care Organization PharmacyA pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO's c…
    225X00000XOccupational TherapistAn occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for O…
    207ZP0213XPediatric Pathology PhysicianA pediatric pathologist is expert in the laboratory diagnosis of diseases that occur during fetal growth, infancy and child development. The practice …
    1835G0000XDeactivated - Pharmacist
    176P00000XFuneral DirectorA person, usually an embalmer, whose business is to arrange for the burial or cremation of the dead and to assist at the funeral rites.
    133N00000XNutritionistA specialist in adapting and applying food and nutrient knowledge to the solution of food and nutritional problems, the control of disease, and the pr…

    Related Payer Policy Updates

    Specialty: Cardiology1 / 3

    6 rows

    PolicyPayerEffective Date
    Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)univerahealthcare2026-10-15
    Cardiovascular Disease Risk AssessmentOscar Health2026-10-01
    Biomarkers for Myocardial Infarction and Chronic Heart FailureOscar Health2026-10-01
    Multiple Procedure Payment Reduction for Diagnostic Cardiovascular ProceduresBlue Cross Blue Shield - Maine2026-10-01
    Cardiovascular Disease Risk Assessmentblue cross blue shield - louisiana2026-09-15
    Cardiovascular Disease Risk AssessmentBlue Cross Blue Shield - New Mexico2026-09-04

    Related Codes

    CPT-32035-THORACOSTOMY-RIB-EXCISION-EMPYEMA

    CPT 32035: Thoracostomy with Rib Excision for Empyema

    CPT-32036-THORACOSTOMY-EVACUATION-OF-EMPYEMA-SKIN-FLAP

    CPT 32036: Thoracostomy for Empyema Drainage with Skin Flap

    CPT-32096-OPEN-PLEURAL-LUNG-BIOPSY

    CPT 32096: Open Surgical Biopsy of Lung/Pleural Space

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

    CPT 32097: Open Pleural Space Biopsy of Lung Mass

    CPT-32098-OPEN-PLEURAL-BIOPSY

    CPT 32098: Open Surgical Pleural Biopsy

    CPT-32100-THORACOTOMY-EXPLORATORY-CHEST-SURGERY

    CPT 32100: Exploratory Thoracotomy, Diagnostic

    CPT-32110-THORACOTOMY-CONTROL-BLEEDING-REPAIR-LUNG

    CPT 32110: Thoracotomy for Hemorrhage Control and Lung Repair

    CPT-32120-THORACOTOMY-SURGICAL-RE-EXPLORATION

    CPT 32120: Thoracotomy for Surgical Re-exploration of Chest

    CPT-32124-THORACOTOMY-PNEUMONOLYSIS

    CPT 32124: Thoracotomy with Pneumonolysis

    CPT-32140-THORACOTOMY-PULMONARY-CYST-EXCISION

    CPT 32140: Thoracotomy for Removal of Lung Cyst(s)

    Showing 1–10 of 17

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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