CPT 32655 Thoracoscopic Bullectomy Reimbursement | OpenPayer

Summary & Overview

CPT 32655: Thoracoscopic Inspection to Assist Removal of Pulmonary Bullae

CPT code 32655 represents a thoracoscopic procedure to visualize the pleura and lungs and assist in removal of pulmonary bullae. Nationally, this code captures minimally invasive thoracic interventions used for symptomatic bullous lung disease or bullectomy performed via endoscopic thoracoscopy. It is relevant to hospital and ambulatory surgical settings and to payers that cover surgical thoracic services. Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn the clinical context for using CPT code 32655, including the procedural intent (visual inspection and assistance with bullectomy), the typical sites of service, and payer coverage considerations. The publication provides benchmarks and coding context for billing and reimbursement, highlights common modifiers associated with surgical procedures, and outlines where to find related documentation and coding guidance. Data not available in the input is noted where relevant, including specific reimbursement rates, ICD-10 diagnoses, related codes, and associated taxonomies.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 32655thoracoscopybullectomythoracic surgeryminimally invasiveambulatory surgical centerhospital operating roomsurgical coding

Billing Code Overview

CPT code 32655 describes a thoracoscopic procedure in which an endoscope is used to visually examine the pleura and lungs to assist in the removal of pulmonary bullae (air-filled cavities within lung tissue). The procedure involves minimally invasive visualization of the thoracic cavity to identify and facilitate resection or bullectomy.

Service type: Thoracoscopic bullectomy/diagnostic thoracoscopy
Typical site of service: Hospital operating room or ambulatory surgical center with thoracic surgery capability

Clinical & Coding Specifications

Clinical Context

A typical patient is a 45–65-year-old smoker or patient with underlying emphysematous lung disease presenting with progressive dyspnea, recurrent spontaneous pneumothorax, or symptomatic large pulmonary bullae on chest imaging. Preoperative evaluation includes history and physical, chest imaging (CT chest to define bullae size and location), pulmonary function testing, and anesthesia assessment. The procedure is performed in an operating room or endoscopy suite under general anesthesia with single-lung ventilation. A thoracoscopic approach (video-assisted thoracoscopic surgery, VATS) is used to visualize the pleura and lung surfaces and facilitate resection or stapling of bullae, with chest tube placement for postoperative drainage. Postoperative workflow includes recovery in post-anesthesia care unit, chest radiograph to confirm lung expansion, pain control, respiratory therapy, monitoring for air leak, and discharge planning with follow-up thoracic surgery or pulmonary clinic visits.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work, time, or complexity substantially exceeds typical for `32655` due to extensive adhesiolysis or complex resection.

Related Codes

CPT-32669-SEGMENTAL-LUNG-RESECTION

CPT 32669: Segmental Lung Resection via Visualization

CPT-32662-MEDIASTINAL-VISUALIZATION-AND-EXCISION

CPT 32662: Mediastinal Visualization and Excision of Cyst or Mass

CPT-32674-MEDIASTINAL-LYMPH-NODE-EXCISION-THORACIC-VISUALIZATION

CPT 32674: Visualization of Chest Cavity with Mediastinal Lymph Node Removal

CPT-32607-VIDEO-ASSISTED-ENDOSCOPIC-LUNG-SAMPLING

CPT 32607: Video-Assisted Endoscopic Sampling of Single Lung

CPT-32651-VIDEO-ASSISTED-PLEURAL-STRIPPING-THORACOSCOPIC-PLEURECTOMY

CPT 32651: Video-Assisted Thoracoscopic Pleural Stripping

CPT-32658-ENDOSCOPIC-PERICARDIAL-CLOT-FOREIGN-BODY-REMOVAL

CPT 32658: Endoscopic Pericardial Clot or Foreign Body Removal

CPT-32659-THORACOSCOPIC-PERICARDIAL-WINDOW-DRAINAGE

CPT 32659: Thoracoscopic Pericardial Window and Drainage

CPT-32654-THORACOSCOPIC-HEMOSTASIS-CHEST-WOUND

CPT 32654: Thoracoscopic Visualization with Hemostasis for Chest Wound

CPT-32604-THORACOSCOPIC-PERICARDIAL-BIOPSY-ENDOSCOPIC-PERICARDIAL-SAMPLING

CPT 32604: Thoracoscopic Pericardial Biopsy, Endoscopic Pericardial Sampling

CPT-32673-THYMECTOMY-THORACOSCOPIC-UNILATERAL-BILATERAL

CPT 32673: Thoracoscopic Thymectomy, Unilateral or Bilateral

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Taxonomy Code	Specialty	Notes
`208K00000X`	Thoracic Surgery	Primary specialty performing thoracoscopic bullae resection.
`2080P0207X`	General Surgery	General surgeons with thoracic experience may perform VATS bullae removal.
`2084P0800X`	Pulmonary Disease	Pulmonologists may perform diagnostic thoracoscopy but typically refer for surgical resection.
`207L00000X`	Anesthesiology	Provides general anesthesia and single-lung ventilation management.
`363L00000X`	Critical Care Medicine	Manages complex perioperative ICU care if postoperative respiratory support is required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J43.8`	Other emphysema	Emphysematous changes with large bullae that may require surgical bullectomy.
`J43.9`	Emphysema, unspecified	General emphysema diagnosis associated with bullae formation.
`J98.2`	Interstitial pulmonary disease, unspecified	May be associated with cystic changes or bullae in select patients.
`J93.9`	Pneumothorax, unspecified	Spontaneous pneumothorax can result from ruptured bullae requiring thoracoscopic intervention.
`R06.02`	Shortness of breath, orthopnea	Symptom code reflecting respiratory compromise prompting surgical evaluation.
`J90`	Pleural effusion, not elsewhere classified	Concurrent pleural effusion may be addressed during thoracoscopy.
`J84.10`	Pulmonary fibrosis, unspecified	Structural lung disease that can coexist with bullae and influence surgical planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32662`	Thoracoscopy, surgical; with lobectomy, with or without mediastinal node dissection	Performed when resection of bullae requires lobectomy rather than isolated bullectomy.
`32480`	Removal of foreign body or lesion from bronchus or lung, bronchoscopic, with biopsy	Diagnostic or therapeutic bronchoscopic procedures may be performed preoperatively or intraoperatively for tissue diagnosis.
`32551`	Thoracentesis, needle or catheter, aspiration of pleural space	May be performed preoperatively for symptomatic pleural effusion management or postoperative drainage in addition to chest tubes.
`32557`	Tube thoracostomy, includes insertion of chest tube for drainage	Commonly performed at the end of `32655` to evacuate air and fluid and manage air leaks.
`31624`	Bronchoscopy, flexible or rigid, diagnostic, with bronchial alveolar lavage	May be used preoperatively to evaluate airway or obtain cultures prior to thoracoscopic surgery.