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CPT 32320: Decortication and Parietal Pleurectomy

CPT code 32320 identifies a thoracic surgical procedure combining decortication and parietal pleurectomy to remove restrictive fibrous pleural tissue and the lining of the chest wall. Nationally, this code captures definitive surgical management for trapped lung, organized empyema, or other pleural processes that limit lung expansion; it is relevant to hospitals, thoracic surgeons, and payers managing high-acuity procedural care. Key payers referenced in typical coverage and reimbursement discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers of this publication will find a concise clinical and billing overview of CPT code 32320, including the clinical context for use, typical sites of service, and common billing modifiers (listed separately). The report outlines benchmarking and payer coverage considerations at a national level, notes common coding pitfalls, and summarizes interplay with related thoracic surgical services. This material is intended to help coding professionals, revenue cycle staff, and clinical administrators confirm appropriate code selection and understand where the procedure sits within thoracic surgical care pathways.

Data not available in the input: associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific policy language.

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Billing Code Overview

CPT code 32320 describes a surgical procedure in which the provider performs decortication to remove a fibrous layer that restricts lung expansion and performs parietal pleurectomy by removing the chest wall lining. This procedure addresses restrictive pleural pathology that impairs lung re-expansion.

Service type: Thoracic surgical procedure to remove fibrous pleural tissue and resect the parietal pleura
Typical site of service: Inpatient or outpatient hospital operating room or specialized surgical suite for thoracic surgery

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CPT 32320: Decortication and Parietal Pleurectomy

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Billing Code Overview

Service type: Thoracic surgical procedure to remove fibrous pleural tissue and resect the parietal pleura
Typical site of service: Inpatient or outpatient hospital operating room or specialized surgical suite for thoracic surgery

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with chronic pleural disease causing restricted lung expansion, frequently after prolonged empyema or persistent fibrous peel formation following traumatic hemothorax or infection. The patient commonly presents with progressive dyspnea, pleuritic chest pain, reduced exercise tolerance, and radiographic evidence of a trapped lung with pleural thickening on chest CT and chest X-ray. Prior conservative management (antibiotics, chest tube drainage, fibrinolytics) has failed to re-expand the lung or resolve the pleural space. Pulmonary function testing often demonstrates a restrictive pattern.

The clinical workflow includes preoperative evaluation (history, physical, imaging, pulmonary risk assessment), informed consent, and perioperative optimization. In the operating room under general anesthesia with single-lung ventilation, the thoracic surgeon performs decortication to remove the fibrous peel restricting the visceral pleura and may perform a parietal pleurectomy to remove diseased parietal pleura. Intraoperative chest tube placement and possible pleural space drainage are performed. Postoperative care involves chest tube management, analgesia, pulmonary hygiene, and monitoring for complications such as bleeding, air leak, infection, or respiratory failure. Hospital admission to a surgical ward or intensive care unit is typical until chest tube removal and clinical stability are achieved.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or time substantially exceeds typical for `32320` due to extensive adhesions or unexpected complexity.
`23`	Unusual anesthesia	Use when general anesthesia cannot be used and a medically appropriate unusual anesthesia technique is required.
`26`	Professional component	Use when reporting only the physician professional component separate from technical facility billing (rare for operative procedures).
`52`	Reduced services	Use when decortication/pleurectomy is partially performed and the service is intentionally reduced.
`53`	Discontinued procedure	Use when the procedure is initiated but terminated due to patient instability or unexpected circumstances before completion.
`54`	Surgical care only	Use when another provider bills for pre- and post-operative care and the surgeon bills only for the intraoperative procedure.
`55`	Postoperative management only	Use when the surgeon provides only postoperative care for `32320`.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons for a complex decortication/pleurectomy.
`80`	Assistant surgeon	Use when an assistant surgeon is required and reports appropriate assistant fee.
`22`	Increased procedural services	Use when additional documentation supports significantly greater work than typical (listed above).

Taxonomy Code	Specialty	Notes
2084P0800X	Thoracic Surgery	Thoracic surgeons commonly perform decortication and pleurectomy.
208600000X	General Surgery	General surgeons with thoracic experience may perform the procedure in some centers.
207RP1001X	Pulmonology	Pulmonologists are involved in preoperative assessment and postoperative pulmonary management.
207L00000X	Pulmonary Critical Care Medicine	Critical care specialists manage perioperative respiratory failure and ICU care when needed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J86.0`	Pyothorax with fistula	Empyema requiring decortication when chronic or organized pleural peel is present.
`J86.9`	Pyothorax without fistula	Acute or chronic empyema that can progress to trapped lung requiring surgical decortication.
`J90`	Pleural effusion, not elsewhere classified	Persistent effusion with pleural thickening may necessitate pleurectomy/decortication when refractory.
`J94.2`	Pleural thickening (fibrothorax)	Direct indication for decortication to remove fibrous peel and restore lung expansion.
`S27.2`	Traumatic hemothorax	Organized hemothorax can lead to fibrothorax requiring decortication/pleurectomy.
`Z48.2`	Encounter for removal of sutures and drains (postoperative care)	Used for postoperative management encounters related to chest tube removal and follow-up care.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32035`	Thoracostomy, with insertion of indwelling tunneled pleural catheter	May be performed prior to definitive decortication for drainage of chronic empyema or recurrent pleural effusion.
`32440`	Decortication, pulmonary (separate listing for extensive or specific approaches)	Related operative code for pleural decortication; surgical approach or extent may influence code selection.
`32601`	Thoracotomy, with repair of lung (wedge resection, etc.)	Performed if concomitant lung resection or repair is required during decortication due to parenchymal disease or injury.
`32551`	Tube thoracostomy, includes water seal (e.g., chest tube)	Commonly performed at the time of decortication/pleurectomy for postoperative drainage.
`36140`	Arterial catheterization or central venous access for perioperative management	Frequently performed for hemodynamic monitoring and postoperative care in complex thoracic surgery.

CPT 32310: Parietal Pleurectomy (Chest Wall Pleurectomy)

CPT-32400-PERCUTANEOUS-PLEURAL-BIOPSY-DIAGNOSTIC-PLEURAL-INTERVENTION

CPT 32400: Percutaneous Pleural Biopsy, Diagnostic Tissue Sampling

CPT-32408-LUNG-MEDIASTINAL-CORE-NEEDLE-BIOPSY-IMAGE-GUIDED

CPT 32408: Image-Guided Core Needle Biopsy of Lung or Mediastinum

References

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.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.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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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or time substantially exceeds typical for `32320` due to extensive adhesions or unexpected complexity.
`23`	Unusual anesthesia	Use when general anesthesia cannot be used and a medically appropriate unusual anesthesia technique is required.
`26`	Professional component	Use when reporting only the physician professional component separate from technical facility billing (rare for operative procedures).
`52`	Reduced services	Use when decortication/pleurectomy is partially performed and the service is intentionally reduced.
`53`	Discontinued procedure	Use when the procedure is initiated but terminated due to patient instability or unexpected circumstances before completion.
`54`	Surgical care only	Use when another provider bills for pre- and post-operative care and the surgeon bills only for the intraoperative procedure.
`55`	Postoperative management only	Use when the surgeon provides only postoperative care for `32320`.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons for a complex decortication/pleurectomy.
`80`	Assistant surgeon	Use when an assistant surgeon is required and reports appropriate assistant fee.
`22`	Increased procedural services	Use when additional documentation supports significantly greater work than typical (listed above).

Taxonomy Code	Specialty	Notes
2084P0800X	Thoracic Surgery	Thoracic surgeons commonly perform decortication and pleurectomy.
208600000X	General Surgery	General surgeons with thoracic experience may perform the procedure in some centers.
207RP1001X	Pulmonology	Pulmonologists are involved in preoperative assessment and postoperative pulmonary management.
207L00000X	Pulmonary Critical Care Medicine	Critical care specialists manage perioperative respiratory failure and ICU care when needed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J86.0`	Pyothorax with fistula	Empyema requiring decortication when chronic or organized pleural peel is present.
`J86.9`	Pyothorax without fistula	Acute or chronic empyema that can progress to trapped lung requiring surgical decortication.
`J90`	Pleural effusion, not elsewhere classified	Persistent effusion with pleural thickening may necessitate pleurectomy/decortication when refractory.
`J94.2`	Pleural thickening (fibrothorax)	Direct indication for decortication to remove fibrous peel and restore lung expansion.
`S27.2`	Traumatic hemothorax	Organized hemothorax can lead to fibrothorax requiring decortication/pleurectomy.
`Z48.2`	Encounter for removal of sutures and drains (postoperative care)	Used for postoperative management encounters related to chest tube removal and follow-up care.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32035`	Thoracostomy, with insertion of indwelling tunneled pleural catheter	May be performed prior to definitive decortication for drainage of chronic empyema or recurrent pleural effusion.
`32440`	Decortication, pulmonary (separate listing for extensive or specific approaches)	Related operative code for pleural decortication; surgical approach or extent may influence code selection.
`32601`	Thoracotomy, with repair of lung (wedge resection, etc.)	Performed if concomitant lung resection or repair is required during decortication due to parenchymal disease or injury.
`32551`	Tube thoracostomy, includes water seal (e.g., chest tube)	Commonly performed at the time of decortication/pleurectomy for postoperative drainage.
`36140`	Arterial catheterization or central venous access for perioperative management	Frequently performed for hemodynamic monitoring and postoperative care in complex thoracic surgery.

CPT 32310: Parietal Pleurectomy (Chest Wall Pleurectomy)

CPT-32400-PERCUTANEOUS-PLEURAL-BIOPSY-DIAGNOSTIC-PLEURAL-INTERVENTION

CPT 32400: Percutaneous Pleural Biopsy, Diagnostic Tissue Sampling

CPT-32408-LUNG-MEDIASTINAL-CORE-NEEDLE-BIOPSY-IMAGE-GUIDED

CPT 32408: Image-Guided Core Needle Biopsy of Lung or Mediastinum

References

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.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.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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CPT 32320: Decortication and Parietal Pleurectomy

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Billing Code Overview

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CPT 32320: Decortication and Parietal Pleurectomy

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References