Summary & Overview
CPT 32906: Rib Excision with Chest Wall Collapse and Bronchopleural Fistula Closure
CPT code 32906 represents an open thoracic surgical procedure in which ribs are excised to cause lateral collapse of the chest wall and pleural cavity, with concurrent closure of a bronchopleural fistula. This procedure is used for serious pleural and pulmonary conditions such as empyema, cavitary tuberculosis, and persistent bronchopleural fistula that have failed less invasive treatments. Nationally, CPT code 32906 is relevant to hospital-based thoracic surgery programs, inpatient surgical management strategies, and payer coverage policies for complex pleural procedures.
Key payers commonly involved when this service is billed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the operation, coding specifics, and the kinds of benchmarking and policy considerations that affect hospital reimbursement and utilization. The publication provides an overview of typical sites of service and service type, clarifies the clinical intent of the procedure, and summarizes typical modifiers and administrative considerations when available. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 32906 describes surgical excision of ribs to remove structural support around the lungs, producing lateral collapse of the chest wall and pleural cavity. The procedure is performed to treat conditions such as empyema, cavitary tuberculosis, or a bronchopleural fistula, and in this instance the surgeon also closes an existing bronchopleural fistula as part of the operation.
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Service type: Open thoracic surgical procedure for pleural space obliteration and bronchopleural fistula repair
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Typical site of service: Inpatient hospital operating room or thoracic surgery suite
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a chronic, loculated pleural space infection such as complex empyema or cavitary pulmonary tuberculosis complicated by a persistent bronchopleural fistula. The patient often presents with fever, pleuritic chest pain, persistent purulent drainage from a chest tube, and failure of medical management including prolonged antibiotics and chest tube drainage with or without fibrinolytics. Imaging (CT chest and chest radiographs) demonstrates an encapsulated pleural collection with thickened pleura and associated rib cage deformity or persistent air leak.
Preoperative workflow includes pulmonary and infectious disease consultation, optimization of nutrition and respiratory status, pleural sampling and microbiology, and informed consent explaining thoracostomy and rib resection with fistula closure. The procedure is typically performed in an operating room under general anesthesia with single-lung ventilation. The surgeon performs rib excision (thoracoplasty) to collapse the chest wall and obliterate the pleural space, and identifies and closes the bronchopleural fistula (may require direct suture repair, muscle flap, or synthetic patch). Postoperative care includes chest tube management, pain control, pulmonary toilet, targeted antimicrobials, and monitoring for recurrent air leak or infection. Typical site of service is an inpatient operating room in a tertiary hospital; ambulatory settings are not appropriate for this invasive thoracic procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |