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Code deleted, see 32096, 32097, 32098

Official Description

Thoracotomy, limited, for biopsy of lung or pleura

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 32095 involves a limited thoracotomy specifically performed for the purpose of obtaining a biopsy from either the lung or the pleura. In this surgical approach, the physician makes a small incision in the anterior chest wall, typically located between the second, third, fourth, or fifth intercostal spaces, depending on the targeted biopsy site. This incision allows access to the thoracic cavity while minimizing trauma to surrounding tissues. During the procedure, the pectoralis and intercostal muscles are carefully divided to expose the pleura, the membrane surrounding the lungs. The ribs are then spread apart to facilitate access to the pleural space. If the biopsy is focused on the pleura, one or more samples of pleural tissue are collected. Conversely, if lung tissue is to be biopsied, the pleura is incised, and the lung may be collapsed as necessary to allow for better visualization and access. Pleural fluid may also be aspirated during this process. Once the lung is adequately exposed, the physician examines the area and proceeds to excise a sample of lung tissue using clamps to secure the biopsy site. After the biopsy is completed, the area is closed with mattress sutures, and a chest tube or catheter may be placed in the pleural space if required. Finally, the lung is reinflated, and the chest incision is closed in layers around the chest tube, ensuring proper healing and recovery.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The limited thoracotomy for biopsy of the lung or pleura, as described by CPT® Code 32095, is indicated for various clinical scenarios where tissue sampling is necessary to diagnose or evaluate conditions affecting the lung or pleural space. The following are specific indications for this procedure:

  • Suspicion of Lung Pathology - When there is a clinical suspicion of lung disease, such as tumors, infections, or inflammatory processes, a biopsy may be required to obtain a definitive diagnosis.
  • Pleural Effusion Evaluation - In cases of unexplained pleural effusion, a biopsy of the pleura can help determine the underlying cause, whether it be malignancy, infection, or other pathological conditions.
  • Assessment of Pleural Disease - The procedure may be indicated for assessing conditions such as pleural thickening or mesothelioma, where tissue samples are necessary for histological examination.

2. Procedure

The procedure for a limited thoracotomy for biopsy of the lung or pleura involves several critical steps, each designed to ensure safe and effective tissue sampling. The following outlines the procedural steps:

  • Step 1: Incision - The surgeon begins by making a small anterior incision between the ribs, typically in the second, third, fourth, or fifth intercostal space, based on the location of the targeted biopsy site. This incision is strategically placed to minimize damage to surrounding structures.
  • Step 2: Muscle Division - Following the incision, the pectoralis and intercostal muscles are carefully divided to expose the pleura, allowing access to the thoracic cavity.
  • Step 3: Rib Spreading - The ribs are then spread apart to provide adequate visibility and access to the pleural space, facilitating the next steps of the procedure.
  • Step 4: Tissue Sampling - If the biopsy is limited to the pleura, one or more tissue samples are taken directly from the pleura. If lung tissue is to be biopsied, the pleura is incised, and the lung may be collapsed as needed to allow for better access. Pleural fluid may also be aspirated during this step.
  • Step 5: Lung Examination - The exposed area of the lung is thoroughly examined to identify any abnormalities or areas of interest for biopsy.
  • Step 6: Tissue Excision - Once the appropriate area is identified, clamps are applied to the biopsy site, and a sample of lung tissue is excised for pathological analysis.
  • Step 7: Closure - After obtaining the biopsy, the area is closed using mattress sutures. A chest tube or catheter may be placed within the pleural space as needed to facilitate drainage and prevent complications.
  • Step 8: Final Closure - The lung is fully inflated, and the chest incision is closed in layers around the chest tube, ensuring proper healing and minimizing the risk of infection.

3. Post-Procedure

Post-procedure care following a limited thoracotomy for biopsy of the lung or pleura involves monitoring the patient for any complications and ensuring proper recovery. Patients may require observation for signs of pneumothorax, bleeding, or infection. The chest tube, if placed, will typically be monitored for drainage and may be removed once the lung is fully re-expanded and there are no further complications. Pain management is also an important aspect of post-operative care, and patients may be prescribed analgesics to manage discomfort. Follow-up appointments will be necessary to discuss biopsy results and any further treatment options based on the findings.

Short Descr BIOPSY THROUGH CHEST WALL
Medium Descr THORACOTOMY LIMITED BIOPSY LUNG/PLEURA
Long Descr Thoracotomy, limited, for biopsy of lung or pleura
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Discontinued Code
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) none
MUE Not applicable/unspecified.
CCS Clinical Classification 38 - Other diagnostic procedures on lung and bronchus
Date
Action
Notes
2012-01-01 Deleted Code deleted, see 32096, 32097, 32098
Pre-1990 Added Code added.
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