2014 Thoracic

Medicare Reimbursement Coding Guide

Effective January 1, 2014
Medicare National Average Rates and Allowables
(Not Adjusted For Geography)
PHYSICIAN
CPT*
HCPCS
Code

Procedure Description

*
MPFS
(CF=$35.8228)
Fac/Non-Fac

AMBULATORY
SURGICAL
CENTER

HOSPITAL OUPATIENT
APC
Classification

APC
Descriptor

APC
Rate

**

ASC

***

DIAGNOSTIC

32096

Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s)

(eg, wedge, incisional), unilateral

$835.39

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32097

Thoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or

mass(es) (eg, wedge, incisional), unilateral

$835.75

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32098

Thoracotomy, with biopsy(ies) of pleura

$788.82

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32100

Thoracotomy; with exploration

$844.70

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32400

Biopsy, pleura; percutaneous needle

$90.63 / $153.68

0685

Level III
Needle Biopsy/
Aspiration
Except Bone
Marrow

$757.76

$418.60

0685

Level III
Needle Biopsy/
Aspiration
Except Bone
Marrow

$757.76

$418.60

32405

Biopsy, lung or mediastinum, percutaneous needle

$107.47 /
$452.08

32601

Thoracoscopy, diagnostic (separate procedure); lungs,

pericardial sac, mediastinal or pleural space, without biopsy

$320.61

0069

Thoracoscopy

$2,640.12

Not reimbursed
in ASC by
Medicare

32604

Thoracoscopy, diagnostic (separate procedure); pericardial sac,

with biopsy

$499.37

0069

Thoracoscopy

$2,640.12

Not reimbursed
in ASC by
Medicare

32606

Thoracoscopy, diagnostic (separate procedure); mediastinal

space, with biopsy

$479.67

0069

Thoracoscopy

$2,640.12

Not reimbursed
in ASC by
Medicare

32607

Thoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s)

(eg, wedge, incisional), unilateral

$320.97

0069

Thoracoscopy

$2,640.12

Not reimbursed
in ASC by
Medicare

32608

Thoracoscopy; with diagnostic biopsy(ies) of lung nodule(s) or

mass(es) (eg, wedge, incisional), unilateral

$394.05

0069

Thoracoscopy

$2,640.12

Not reimbursed
in ASC by
Medicare

32609

Thoracoscopy; with biopsy(ies) of pleura

$271.90

0069

Thoracoscopy

$2,640.12

Not reimbursed
in ASC by
Medicare

PHYSICIAN
CPT*
HCPCS
Code

Procedure Description

*
MPFS
(CF=$35.8228)
Fac/Non-Fac

AMBULATORY
SURGICAL
CENTER

HOSPITAL OUPATIENT
APC
Classification

APC
Descriptor

APC
Rate

**

ASC

***

EXCISION

32110

Thoracotomy; with control of traumatic hemorrhage and/or

repair of lung tear

32120

Thoracotomy; for postoperative complications

32140

$1,507.07

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

$902.73

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

Thoracotomy; with cyst(s) removal, includes pleural procedure

when performed

$1,027.40

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32141

Thoracotomy; with resection-plication of bullae, includes any

pleural procedure when performed

$1,587.67

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32150

Thoracotomy; with removal of intrapleural foreign body or

fibrin deposit

$1,040.29

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32151

Thoracotomy; with removal of intrapulmonary foreign body

$1,037.07

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32160

Thoracotomy; with cardiac massage

$814.61

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32440

Removal of lung, pneumonectomy;

$1,623.85

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32442

Removal of lung, pneumonectomy; with resection of segment

of trachea followed by broncho-tracheal anastomosis (sleeve
pneumonectomy)

$3,332.95

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32445

Removal of lung, pneumonectomy; extrapleural

$3,667.18

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32480

Removal of lung, other than pneumonectomy; single lobe

(lobectomy)

$1,533.93

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32482

Removal of lung, other than pneumonectomy; 2 lobes

(bilobectomy)

$1,642.83

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32484

Removal of lung, other than pneumonectomy; single segment

(segmentectomy)

$1,488.08

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32486

Removal of lung, other than pneumonectomy; with

circumferential resection of segment of bronchus followed by
broncho-bronchial anastomosis (sleeve lobectomy)

$2,437.38

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32488

Removal of lung, other than pneumonectomy; with all

remaining lung following previous removal of a portion of lung
(completion pneumonectomy)

$2,491.12

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32491

Removal of lung, other than pneumonectomy; with resectionplication of emphysematous lung(s) (bullous or non-bullous)
for lung volume reduction, sternal split or transthoracic
approach, includes any pleural procedure, when performed

$1,524.62

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

+325011

Resection and repair of portion of bronchus (bronchoplasty)

when performed at time of lobectomy or segmentectomy (List
separately in addition to code for primary procedure)

$254.70

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32650

Thoracoscopy, surgical; with pleurodesis (eg, mechanical or

chemical)

$688.87

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32651

Thoracoscopy, surgical; with partial pulmonary decortication

$1,132.36

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32652

Thoracoscopy, surgical; with total pulmonary decortication,

including intrapleural pneumonolysis

$1,720.21

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32653

Thoracoscopy, surgical; with removal of intrapleural foreign

body or fibrin deposit

$1,094.74

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32654

Thoracoscopy, surgical; with control of traumatic hemorrhage

$1,215.83

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32655

Thoracoscopy, surgical; with resection-plication of bullae,

includes any pleural procedure when performed

$989.43

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32656

Thoracoscopy, surgical; with parietal pleurectomy

$826.07

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32658

Thoracoscopy, surgical; with removal of clot or foreign body

from pericardial sac

$739.02

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32659

Thoracoscopy, surgical; with creation of pericardial window or

partial resection of pericardial sac for drainage

$756.94

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32661

Thoracoscopy, surgical; with excision of pericardial cyst, tumor,

or mass

$826.79

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32662

Thoracoscopy, surgical; with excision of mediastinal cyst, tumor,

or mass

$926.02

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

PHYSICIAN
CPT*
HCPCS
Code

Procedure Description

*
MPFS
(CF=$35.8228)
Fac/Non-Fac

AMBULATORY
SURGICAL
CENTER

HOSPITAL OUPATIENT
APC
Classification

APC
Descriptor

APC
Rate

**

ASC

***

32663

Thoracoscopy, surgical; with lobectomy (single lobe)

$1,452.26

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32664

Thoracoscopy, surgical; with thoracic sympathectomy

$878.73

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32665

Thoracoscopy, surgical; with esophagomyotomy (Heller type)

$1,263.11

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32666

Thoracoscopy, surgical; with therapeutic wedge resection (eg,

mass, nodule), initial unilateral

$901.66

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

+326672

Thoracoscopy, surgical; with therapeutic wedge resection (eg,

mass or nodule), each additional resection, ipsilateral (List
separately in addition to code for primary procedure)

$164.07

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

+326683

Thoracoscopy, surgical; with diagnostic wedge resection

followed by anatomic lung resection (List separately in addition
to code for primary procedure)

$164.07

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

$976.89

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

$803.86

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

HERNIA

32800

Repair lung hernia through chest wall

PLEURAL

32036

Thoracostomy; with open flap drainage for empyema

32124

Thoracotomy; with open intrapleural pneumonolysis

32200

Pneumonostomy, with open drainage of abscess or cyst

$961.84

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

$1,173.91

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32215

Pleural scarification for repeat pneumothorax

$828.22

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32220

Decortication, pulmonary (separate procedure); total

$1,643.55

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32225

Decortication, pulmonary (separate procedure); partial

$1,030.62

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32310

Pleurectomy, parietal (separate procedure)

$950.74

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32320

Decortication and parietal pleurectomy

$1,655.01

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32505

Thoracotomy; with therapeutic wedge resection (eg, mass,

nodule), initial

$964.35

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

+325064

Thoracotomy; with therapeutic wedge resection (eg, mass or

nodule), each additional resection, ipsilateral (List separately in
addition to code for primary procedure)

$163.71

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

+325075

Thoracotomy; with diagnostic wedge resection followed by

anatomic lung resection (List separately in addition to code for
primary procedure)

$163.71

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare

32540

Extrapleural enucleation of empyema (empyemectomy)

$1,800.10

49405

Image-guided fluid collection drainage by catheter (eg, abscess,

hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver,
spleen, lung/mediastinum), percutaneous

$220.31 /
$886.26

0037

Level IV
Needle Biopsy/
Aspiration
Except Bone
Marrow

$1,223.25

Not reimbursed
in ASC by
Medicare

NOTES:
1
Use 32501 in conjunction with 32480, 32482, 32484.
2
Report 32667 only in conjunction with 32666.
3
Report 32668 in conjunction with 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32503, 32504, 32663, 32669, 32670, 32671.
4
Report 32506 only in conjunction with 32505.
5
Report 32507 in conjunction with 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32503, 32504.
Multiple Procedure Discounting Multiple surgical procedures furnished during the same operative session are discounted.
50% is paid for any other surgical procedure(s) performed at the same time.
The above National Average APC and ASC (Freestanding) Rates represent the reimbursement amounts paid directly to the facility for the technical portion of the procedure. The Physician (surgeon) would separately receive the professional
fee (MPFS Allowable) for the procedure performed.
+
CY 2014 CPT Code Manual parenthetical instruction: CPT 32201 (Pneumonostomy; with percutaneous drainage of abscess or cyst) has been deleted CY 2014. For percutaneous image-guided draining of abscess or cyst of lungs or
mediastinum by catheter placement, use CPT 49405 (Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous); new code added
for CY 2014.
TABLE REFERENCES:
* PFS Relative Value File, RVU14A (12-19-13), effective January 1, 2014
** January 2014 HOPPS Addenda A and B (12-19-13), effective January 1, 2014
*** January 2014 ASC Addendum AA, BB, DD1, DD2, and EE (1-2-14), effective January 1, 2014

ICD-9-CM Volume 3 Hospital Procedure Codes

Procedure Code*

Description

32.20

Thoracoscopic excision of lesion or tissue of lung

32.21

Plication of emphysematous bleb

32.22

Lung volume reduction surgery

32.29

Other local excision or destruction of lesion or tissue of lung

32.30

Thoracoscopic segmental resection of lung

32.39

Other and unspecified segmental resection of lung

32.41

Thoracoscopic lobectomy of lung

32.49

Other lobectomy of lung

32.50

Thoracoscopic pneumonectomy

32.59

Other and unspecified pneumonectomy

32.6

Radical dissection of thoracic structures

32.9

Other excision of lung

33.20

Thoracoscopic lung biopsy

33.24

Closed [endoscopic] biopsy of bronchus

33.25

Open biopsy of bronchus

33.26

Closed [percutaneous] [needle] biopsy of lung

33.27

Closed endoscopic biopsy of lung

33.28

Open biopsy of lung

33.29

Other diagnostic procedures on lung or bronchus

34.06

Thoracoscopic drainage of pleural cavity

34.20

Thoracoscopic pleural biopsy

34.21

Transpleural thoracoscopy

34.22

Mediastinoscopy

34.23

Biopsy of chest wall

34.24

Other pleural biopsy

34.25

Closed [percutaneous] [needle] biopsy of mediastinum

34.26

Open mediastinal biopsy

34.27

Biopsy of diaphragm

34.28

Other diagnostic procedures on chest wall, pleura, and diaphragm

34.29

Other diagnostic procedures on mediastinum

34.3

Excision or destruction of lesion or tissue of mediastinum

34.4

Excision or destruction of lesion of chest wall

34.51

Decortication of lung

34.52

Thoracoscopic decortication of lung

34.59

Other excision of pleura

NOTES:
The ICD-9-CM Hospital Procedure Codes listed above may be used in the MS-DRG Classifications (See Inpatient DRG Payment Rates Table)
The appropriate MS-DRG classification is also dependent on the diagnosis code, demographics, sex and possible co-conditions.
TABLE REFERENCES:
*
2014 Hospital ICD-9-CM Volume 3, 9th Revision, Clinical Modification, Sixth Edition

Inpatient DRG Payment Rates

MS-DRG*

MS-DRG Title

Arithmetic Mean Length

of Stay (Days)

National Average
Payment**

163

Major Chest Procedures w MCC

13.4

$29,550.07

164

Major Chest Procedures w CC

6.7

$15,128.81

165

Major Chest Procedures w/o CC/MCC

4.0

$10,406.20

166

Other Resp System O.R. Procedures w MCC

11.2

$21,308.27

167

Other Resp System O.R. Procedures w CC

6.6

$11,517.99

168

Other Resp System O.R. Procedures w/o CC/MCC

3.9

$7,598.04

MS-DRG*

MS-DRG Title

Arithmetic Mean Length

of Stay (Days)

National Average
Payment**

820

Lymphoma & Leukemia w Major O.R. Procedure w MCC

17.1

$34,089.41

821

Lymphoma & Leukemia w Major O.R. Procedure w CC

6.9

$13,933.51

822

Lymphoma & Leukemia w Major O.R. Procedure w/o CC/MCC

2.8

$7,154.37

981

Extensive O.R. Procedure Unrelated to Principal Diagnosis w MCC

13.1

$28,603.00

982

Extensive O.R. Procedure Unrelated to Principal Diagnosis w CC

7.6

$16,531.15

983

Extensive O.R. Procedure Unrelated to Principal Diagnosis w/o CC/MCC

3.8

$10,127.24

NOTE:
*
One DRG per patient is assigned to each inpatient stay.
TABLE REFERENCES:
**
FY 2014 Final Rule, Federal Register, Vol. 78, No. 160, Monday, August 19, 2013, Table 1A-1E. National Average Payment Rate is based upon
the National Average Operating Standardized Amount ($5,370.28) plus the Capital Standard Federal Payment Rate ($429.31).

ICD-9-CM Diagnosis Codes

Dx Code**

Description

162.x*

Malignant neoplasm of trachea, bronchus, and lung

197.0

Secondary malignant neoplasm of lung

235.7

Neoplasm of uncertain behavior of trachea, bronchus, and lung

239.1

Neoplasm of unspecified nature of respiratory system

492.x*

Emphysema

510.x

Empyema

511.x*

Pleurisy

512.xx

Pneumothorax and air leak

518.xx*

Other diseases of lung

786.xx

Symptoms involving respiratory system and other chest symptoms

793.11

Solitary pulmonary nodule

793.19

Other nonspecific abnormal finding of lung field

NOTES:
*
Check 4th or 5th digit.
TABLE REFERENCES:
**
2014 Hospital ICD-9-CM Volume 1 and 2, 9th Revision, Clinical Modification, Sixth Edition

Disclaimer:
The information contained in this guide is provided to help you understand the reimbursement process. It is not intended to increase or maximize reimbursement by any
payer. We strongly recommend that providers consult their payer organization with regard to local reimbursement policies. The information contained in this guide is
provided for information purposes only and represents no statement, promise or guarantee by Covidien concerning levels of reimbursement, payment or charge.
Similarly, all CPT HCPCS and ICD-9-CM codes are supplied for information purposes only and represent no statement, promise or guarantee by Covidien that these
codes will be appropriate or that reimbursement will be made. ICD-9-CM is based on the official version of the World Health Organizations Ninth Revision, International
Classification of Diseases. CPT codes and descriptions only are copyright 2013 American Medical Association. All rights reserved.
CPT does not include fee schedules, relative values or related listings. The source for this information is the Centers for Medicare and Medicaid Services (CMS).
Reimbursement rates reflected in this guide are Medicare National Average rates as published by CMS at the time of printing, and do not reflect provider payment
adjustment factors such geographic adjustment, participation as a Disproportionate Share or Teaching Hospital, participation in the CMS Shared Service (ACO) program,
or Value Base Purchasing adjustments. The content provided by CMS is updated frequently. It is the responsibility of the health services provider to confirm the appropriate
coding required by their local Medicare Administrative Contractors (MACs), carriers, fiscal intermediaries and commercial payers.
All Current Procedural Terminology (CPT) five-digit numeric codes, descriptions, numeric modifiers, instructions, guidelines and other material are copyright 2013
American Medical Association. All rights reserved.
Code associations and values have been reviewed and validated by NMD Healthcare, Inc.

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