CPT® Code 32658

The procedure described by CPT® Code 32658 involves a surgical thoracoscopy, which is a minimally invasive technique used to access the thoracic cavity. Specifically, this procedure focuses on the pericardial sac, the fibrous membrane that encases the heart. During this operation, the physician utilizes video-assisted thoracoscopic surgery (VATS) to remove either a clot or a foreign body that may be present within the pericardial sac. The approach typically begins with the creation of a small incision between the ribs, often located at the sixth or seventh intercostal space along the anterior axillary line. This incision allows for the introduction of a videothoracoscope, a specialized camera that provides visual access to the thoracic cavity. To facilitate the procedure, two additional portal incisions are made at the posterior axillary line, generally at the fifth and eighth intercostal spaces, which enable the insertion of surgical instruments necessary for the operation. As part of the procedure, one lung is intentionally collapsed to provide a clearer view and access to the pericardial sac. The inferior pulmonary ligament is divided to further enhance access, and the phrenic nerve, which is crucial for diaphragm function, is carefully identified and protected throughout the process. In cases where blunt trauma has led to the formation of a pericardial blood clot, the surgeon will grasp and retract the pericardium away from the heart to gain better access. Endoscopic scissors are then introduced to nick the pericardium, allowing for the evacuation of blood and fluid. The surgeon examines the pericardium to locate the blood clot or any foreign body that may need to be removed. Once the clot or foreign body is successfully extracted, any bleeding is controlled, and chest tubes may be placed as necessary to facilitate drainage. Finally, the incisions made during the procedure are closed, completing the surgical intervention.