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    v1.0.28
    OpenPayerBilling CodesThoracoscopy (Video-assisted thoracic surgery [VATS]) on the Lungs and PleuraCPT cpt-32659-thoracoscopic-pericardial-window-drainage
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    CPT 32659: Thoracoscopic Pericardial Window with Drainage

    Medicare pays $724 on average nationally for this procedure.

    CPT code 32659 describes a thoracoscopic procedure to visualize the pericardial sac with an endoscope, incise the pericardium, and create a pericardial flap or window to drain pericardial fluid; this is a thoracoscopic pericardial window with drainage typically performed as a surgical therapeutic drainage procedure in an operating room or procedural suite under general anesthesia for diagnostic and palliative management of pericardial effusion or tamponade.

    For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult who presents with symptomatic pericardial effusion causing dyspnea, hypotension, chest discomfort, or echocardiographic evidence of tamponade physiology. Evaluation includes history, physical exam, transthoracic echocardiography confirming a clinically significant effusion, laboratory studies, and cardiology or cardiothoracic surgery consultation. When percutaneous pericardiocentesis is inadequate, or when direct visualization and creation of a pericardial window is preferred (for example to prevent recurrent effusion or to obtain tissue/biopsy), a thoracoscopic pericardial window is performed under general anesthesia. The patient is positioned for thoracoscopy, standard sterile technique is used, and endoscopic ports are placed. The pericardial sac is inspected with an endoscope, an incision is made in the pericardium, and a flap or window is created to allow continuous drainage of fluid into the pleural or mediastinal space or to permit placement of a drain. Typical intraoperative steps include endoscopic visualization, controlled incision of the pericardium, fluid evacuation, possible biopsy of the pericardium, hemostasis, and placement of a chest or pericardial drain if indicated. Postoperative care includes monitoring in a recovery area or intensive care setting depending on hemodynamics, serial echocardiography as indicated, pain control, and management of drains. Typical site of service is an operating room or thoracic procedural suite in an inpatient or same-day surgery setting. Common clinical indications include malignant pericardial effusion, bacterial or tuberculous pericarditis with effusion, uremic pericarditis with recurrent effusion, postpericardiotomy effusion, and large idiopathic effusions causing hemodynamic compromise.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    33030Pericardiocentesis, needle aspiration, including imaging guidance when performedOften performed prior to or instead of thoracoscopic window for diagnostic or emergent drainage; may precede definitive window if fluid reaccumulates.
    33020Pericardiostomy; subxiphoid (open) with creation of pericardial windowAn open surgical alternative to thoracoscopic pericardial window; selected based on clinical factors and surgeon preference.
    32551Thoracotomy with partial pericardiectomy or pericardial window (open)Related open thoracic approaches for pericardial disease when endoscopic approach is not feasible.
    32505Thoracoscopic biopsy; pericardial/mediastinal tissue biopsyPericardial biopsy may be performed at the time of thoracoscopic pericardial window for diagnostic evaluation.
    93451Right heart catheterization including measurement of cardiac output and sampling; with pericardiocentesis if performedHemodynamic assessment and cath procedures may be performed in complex cases; used selectively in management planning.

    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…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    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…
    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…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    207P00000XEmergency Medicine PhysicianAn emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
    163W00000XRegistered Nurse(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
    363LF0000XFamily Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    376J00000XHomemakerAn individual who provides general household activities such as meal preparation, laundry, and light housekeeping, when the individual regularly respo…
    171000000XMilitary Health Care ProviderActive duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative …
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    207QA0000XAdolescent Medicine (Family Medicine) PhysicianA family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their …

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    A41.9Sepsis, unspecified organism
    I26.99Other pulmonary embolism without acute cor pulmonale
    I30.0Acute nonspecific idiopathic pericarditis
    I30.1Infective pericarditis
    I30.8Other forms of acute pericarditis
    I30.9Acute pericarditis, unspecified
    I31.0Chronic adhesive pericarditis
    I31.1Chronic constrictive pericarditis
    I31.2Hemopericardium, not elsewhere classified
    I31.4Cardiac tamponade

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21
    Mm_0579_Coveragepositioncriteria_Anesthesia_Services_Selected_Nerve_BlocksCigna2026-05-15
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric DisordersBlue Cross Blue Shield - North Carolina2026-04-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric DisordersBlue Cross Blue Shield - North Carolina2026-04-01

    Related Codes

    CPT-32601-DIAGNOSTIC-THORACIC-ENDOSCOPY-LUNG-MEDIASTINUM-PLEURA

    CPT 32601: Diagnostic Thoracoscopic/Endoscopic Examination of Lung or Pleural Spaces

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

    CPT 32604: Thoracoscopic Pericardial Biopsy

    CPT-32606-THORACOSCOPIC-MEDIASTINAL-BIOPSY

    CPT 32606: Mediastinoscopy with Mediastinal Biopsy

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

    CPT 32607: Video-Assisted Endoscopic Sampling of Single Lung

    CPT-32608-VIDEO-ASSISTED-ENDOSCOPIC-LUNG-NODULE-BIOPSY

    CPT 32608: Video-Assisted Endoscopic Lung Nodule Biopsy

    CPT-32609-VIDEO-ASSISTED-PLEURAL-BIOPSY-THORACOSCOPIC

    CPT 32609: Pleural Biopsy, Video-Assisted Endoscopic Approach

    CPT-32650-THORACOSCOPIC-PLEURODESIS

    CPT 32650: Thoracoscopy-Assisted Pleurodesis

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

    CPT 32651: Video-Assisted Pleurectomy/Stripping of Parietal Pleura

    CPT-32652-THORACOSCOPIC-LUNG-DECORTICATION-VIDEO-ASSISTED

    CPT 32652: Video-Assisted Pleurectomy and Decortication

    CPT-32653-VIDEO-ASSISTED-THORACOSCOPIC-FOREIGN-BODY-REMOVAL

    CPT 32653: Video-Assisted Thoracoscopic Removal of Pleural Foreign Body

    Showing 1–10 of 28

    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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