CPT® Code 32503

Resection of apical lung tumor (eg, Pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; without chest wall reconstruction(s)

The procedure described by CPT® Code 32503 involves the surgical resection of a tumor located at the apex of the lung, commonly referred to as a Pancoast tumor. These tumors are characterized by their tendency to invade surrounding structures, including the chest wall, lymphatic vessels, and various neural components such as the brachial plexus and intercostal nerves. The surgical approach typically requires a posterolateral thoracotomy incision, which is strategically made below the shoulder blade and extends around the rib curvature to the front of the chest. This incision allows for adequate exposure of the lung apex and the surrounding anatomical structures. During the procedure, the surgeon may need to remove portions of the first, second, and sometimes third ribs to access the tumor effectively. If the tumor has infiltrated neurological structures, dissection and severing of specific nerve roots may be necessary. In cases where the tumor extends into the intervertebral foramen, additional procedures such as hemilaminectomy or vertebral body resection may be performed. The ultimate goal of the surgery is to mobilize and completely resect the apical lung mass, which may involve the removal of the apical lung segment, upper lobe, or in rare instances, the entire lung along with the affected chest wall. Following the resection, chest tubes are typically placed to facilitate drainage, and the incision is closed with sutures. It is important to note that if chest wall reconstruction is required after the tumor resection, a different CPT® code, 32504, should be reported.