Summary & Overview
CPT 32540: Excision of Empyema with Pleural Lining
CPT code 32540 denotes surgical excision of an intact empyema located above the pleural surface, with removal of surrounding pleural lining. This thoracic surgical code captures definitive operative management for localized pleural-space abscesses and is relevant for hospitals and surgical practices that manage pleural infections. Nationally, accurate coding for 32540 affects clinical documentation, case mix reporting, and facility billing for operative thoracic care.
Key payers covered in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 32540, typical sites of service, and the kinds of benchmarks and policy issues that influence payment and utilization, including payer coverage practices and coding validation considerations. The publication summarizes expected documentation elements, common billing modifiers (listed separately), and operational considerations for hospital billing departments.
This summary equips clinical coders, revenue cycle managers, and policy analysts with the foundational understanding of CPT code 32540 needed to align clinical records with billing and reimbursement processes. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 32540 describes the surgical removal of an intact abscess (empyema) located above the pleura, including excision of the surrounding pleural lining. This procedure involves direct operative management of a pleural-space empyema and removal of infected material together with affected pleural tissue.
-
Service type: Surgical procedure (thoracic surgery)
-
Typical site of service: Inpatient or outpatient hospital operating room, or other procedural areas equipped for thoracic surgery
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with a recent history of complicated pneumonia presents with fever, pleuritic chest pain, and increasing shortness of breath. Imaging (chest CT and ultrasound) demonstrates a loculated pleural fluid collection with thickened pleura consistent with an empyema. The patient is optimized preoperatively, informed consent is obtained, and the thoracic surgery team schedules a surgical decortication and evacuation of empyema under general anesthesia. Intraoperative steps include thoracostomy, inspection of the pleural space, removal of the purulent collection and organized fibrinous peel from the visceral pleura, control of bleeding, and placement of one or more chest tubes for postoperative drainage. Postoperative workflow includes PACU recovery, chest tube management, targeted antibiotics guided by cultures, chest imaging to confirm re-expansion, and discharge planning with outpatient follow-up for chest tube removal and pulmonary rehabilitation as needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier, standard service reporting | Use as the default when no modifier applies |
| 11 | Normally expected performance of the service | Use for primary procedure reporting when no unusual circumstances |
| 22 | Increased procedural services | Use when work required is substantially greater than typical (document rationale) |