CPT 39561 Diaphragm Resection Reimbursement | OpenPayer

Summary & Overview

CPT 39561: Diaphragm Resection with Involved Repair

CPT code 39561 denotes surgical resection of the diaphragm with involved repair, which may involve prosthetic reinforcement or local muscle flap closure. This procedure is typically used to remove diseased tissue resulting from tumor invasion of the diaphragmatic area and carries implications for surgical oncology, thoracic surgery, and perioperative resource planning. Nationally, the code matters for proper classification of complex thoracoabdominal oncologic procedures, hospital billing, and tracking utilization of reconstructive techniques.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and typical sites of service, plus benchmarks and policy-relevant considerations for coverage and coding of complex diaphragm resections. The publication outlines typical coding relationships, common modifiers used in practice (listed separately), and areas where institutional documentation affects payment and audit risk. Clinical teams and revenue cycle stakeholders will gain concise guidance on how this code is positioned within surgical oncology services, expected operative settings, and the administrative elements that influence reimbursement and claims adjudication.

Data not available in the input: associated taxonomies, ICD-10 diagnoses, related codes, and payer-specific coverage edits.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare39561CPTdiaphragm resectionthoracic surgerysurgical oncologyoperative repairprosthetic repairmuscle flap

Billing Code Overview

CPT code 39561 describes a surgical procedure in which the provider resects the diaphragm and performs an involved repair. The repair may include placement of prosthetic material or closure using a local muscle flap. The procedure is commonly performed to excise diseased tissue after tumor spread into the diaphragmatic area.

Service type: Surgical resection and repair of the diaphragm
Typical site of service: Operating room (inpatient or outpatient surgical setting, depending on clinical context and extent of resection)

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with a history of advanced non-small cell lung carcinoma presents with radiographic evidence of tumor invasion into the right hemidiaphragm with localized diaphragmatic mass and chest wall pain. Multidisciplinary tumor board recommends surgical resection of involved diaphragm tissue to achieve local control. The patient is evaluated preoperatively with chest CT and PET to define extent of disease and fitness for anesthesia. In the operating room under general endotracheal anesthesia, a thoracic surgeon performs an open thoracotomy, resects the involved segment of diaphragm using an involved repair technique, and reconstructs the defect with either primary layered closure, a local muscle flap, or placement of prosthetic mesh as needed. Intraoperative frozen section may be used to assess margins. Postoperative care includes chest tube management, pain control, pulmonary hygiene, and surveillance imaging. The procedure is commonly billed when diaphragmatic tissue is excised for tumor spread or other localized disease requiring an involved repair and possible prosthetic reconstruction.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the diaphragm resection and repair required substantially greater effort, time, or complexity than usual.
`23`

CPT 39503: Congenital Diaphragmatic Hernia Repair, Newborn

CPT-39545-DIAPHRAGMATIC-PLICATION-REPAIR-ELEVATED-DIAPHRAGM

CPT 39545: Diaphragmatic Plication for Elevated Diaphragm

CPT-39560-DIAPHRAGM-RESECTION-AND-PRIMARY-REPAIR

CPT 39560: Diaphragm Resection and Primary Repair

CPT-39501-DIAPHRAGM-REPAIR-TRAUMATIC-TEAR

CPT 39501: Repair of Diaphragmatic Tear from Trauma

CPT-39540-TRAUMATIC-DIAPHRAGMATIC-HERNIA-REPAIR

CPT 39540: Surgical Repair of Traumatic Diaphragmatic Hernia

CPT-39541-RECURRENT-TRAUMATIC-DIAPHRAGMATIC-HERNIA-REPAIR

CPT 39541: Repair of Recurrent Traumatic Diaphragmatic Hernia

Taxonomy Code	Specialty	Notes
2084P0800X	Thoracic Surgery	Thoracic surgeons commonly perform diaphragmatic resections during thoracotomy for tumor invasion.
2080P0202X	General Surgery	General surgeons with thoracic experience may perform diaphragm resections, especially for abdominal-origin tumors extending into the chest.
2086S0121X	Surgical Oncology	Surgical oncologists perform en bloc resections involving diaphragm tissue for malignancy control.
207RH0000X	Otolaryngology - Head & Neck Surgery	Selected head and neck surgeons may participate when tumors extend inferiorly to the diaphragm region in complex resections.
207L00000X	Plastic and Reconstructive Surgery	Plastic surgeons may assist with complex diaphragmatic reconstruction using muscle flaps or prosthetic placement.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C78.7`	Secondary malignant neoplasm of liver and intrahepatic bile duct	Tumors metastasizing to or near the diaphragm may necessitate resection when invading the diaphragmatic surface.
`C78.6`	Secondary malignant neoplasm of retroperitoneum and peritoneum	Peritoneal or retroperitoneal tumors can invade the diaphragm and require partial resection and repair.
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Primary lung tumors that invade the diaphragm often require diaphragmatic resection for local control.
`C41.9`	Malignant neoplasm of bone and articular cartilage, unspecified	Tumors of adjacent bony structures that extend to the diaphragm may necessitate combined resection.
`K44.9`	Diaphragmatic hernia without obstruction or gangrene	When hernia involves significant tissue defect from tumor resection, diaphragm repair technique from `39561` may be used.
`T81.31XA`	Disruption of wound, not elsewhere classified, initial encounter	Postoperative complication that may require return to OR for repair of diaphragm site.
`Z90.2`	Acquired absence of lung [partial or total]	Relevant in complex thoracic resections where diaphragmatic repair is performed in patients with prior lung resection.
`D49.1`	Neoplasm of uncertain behavior of respiratory system and intrathoracic organs	Lesions of uncertain behavior involving the diaphragm may be resected for diagnosis and control.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32551`	Thoracotomy with chest tube placement (insertion)	Chest access and postoperative chest tube management commonly accompany diaphragmatic resection performed via thoracotomy.
`35531`	Excision, chest wall tumor; full-thickness including diaphragm if performed separately	Performed when chest wall tumor resection is required in addition to diaphragmatic resection; may be done in same operative session.
`15734`	Muscle or myocutaneous flap; trunk	Used when a local muscle flap is harvested to reconstruct the diaphragm defect.
`49568`	Implantation of mesh or other prosthesis for hernia or diaphragm repair (similar prosthetic placement)	Applied when prosthetic material is used to close the diaphragmatic defect after resection.
`88305`	Surgical pathology, gross and microscopic examination	Used for histopathologic evaluation of resected diaphragmatic tissue and margin assessment.

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