Summary & Overview
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.
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.
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Service type: Thoracic surgical procedure to remove fibrous pleural tissue and resect the parietal pleura
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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 |