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CPT®
32660

CPT® Code 32660
Deleted

Official Description

Thoracoscopy, surgical; with total pericardiectomy

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 32660 involves a surgical thoracoscopy, specifically a total pericardiectomy. This surgical technique is utilized to address conditions affecting the pericardium, which is the fibrous membrane encasing the heart. During the procedure, the physician creates a pericardial window or performs a partial resection of the pericardial sac to facilitate drainage. The approach typically involves making a small incision between the ribs, often at the sixth or seventh intercostal space along the anterior axillary line, through which a videothoracoscope is introduced. This minimally invasive technique allows for enhanced visualization and access to the pericardial space. To perform the total pericardiectomy, additional incisions are made at the posterior axillary line, usually at the fifth and eighth intercostal spaces, to accommodate the surgical instruments necessary for the procedure. The inferior pulmonary ligament is divided to gain better access, and the phrenic nerve, which is crucial for diaphragm function, is carefully identified and protected throughout the operation. The pericardium is then grasped and retracted away from the heart, allowing the surgeon to use endoscopic scissors to make an incision in the pericardium. This incision facilitates the evacuation of blood and fluid from the pericardial space. The procedure may involve resecting a section of the pericardial sac, typically measuring three to four centimeters, to create a pericardial window or to perform a more extensive resection. The pericardium is examined, and a sponge may be introduced to break up any loculations present. If necessary, a second window can be created using the same technique. To ensure proper drainage post-surgery, a chest tube is placed into the pericardial window, and an additional chest tube is inserted into the pleural space. The total pericardiectomy is completed by resecting the pericardium as extensively as possible, followed by the placement of chest tubes and closure of the incisions. This procedure is critical for managing conditions that lead to fluid accumulation or other complications within the pericardial space.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 32660 is indicated for various conditions affecting the pericardium, which may include:

  • Pericardial effusion: Accumulation of fluid in the pericardial space that may require drainage to relieve pressure on the heart.
  • Constrictive pericarditis: Thickening and fibrosis of the pericardium that restricts heart function and may necessitate resection.
  • Cardiac tamponade: A serious condition where fluid accumulation compresses the heart, impairing its ability to pump effectively.
  • Infectious pericarditis: Inflammation of the pericardium due to infection, which may require surgical intervention if conservative treatments fail.

2. Procedure

The surgical procedure for CPT® Code 32660 involves several critical steps to ensure effective access and treatment of the pericardial space:

  • Step 1: The procedure begins with the patient positioned appropriately, and anesthesia administered. A small incision is made between the ribs, typically at the sixth or seventh intercostal space along the anterior axillary line, to introduce the videothoracoscope.
  • Step 2: Following the initial incision, two additional portal incisions are created at the posterior axillary line, usually at the fifth and eighth intercostal spaces. These incisions allow for the introduction of surgical instruments necessary for the procedure.
  • Step 3: The inferior pulmonary ligament is divided to enhance access to the pericardial space. The phrenic nerve is carefully identified and protected throughout the procedure to prevent any damage that could affect diaphragm function.
  • Step 4: The pericardium is grasped and retracted away from the heart, allowing the surgeon to introduce endoscopic scissors. An incision is made in the pericardium, which facilitates the evacuation of blood and fluid from the pericardial space.
  • Step 5: A pericardial window or partial resection of the pericardial sac is performed by resecting a section of the pericardial sac, typically measuring three to four centimeters. This step is crucial for alleviating pressure and allowing for drainage.
  • Step 6: The pericardium is examined for any loculations, and a sponge may be introduced to break them up. If necessary, a second window can be created using the same technique to ensure adequate drainage.
  • Step 7: To facilitate post-operative drainage, a chest tube is placed into the pericardial window, and a second chest tube is inserted into the pleural space. This is essential for preventing fluid accumulation after the procedure.
  • Step 8: Finally, the incisions are closed, completing the total pericardiectomy using surgical thoracoscopy.

3. Post-Procedure

After the completion of the total pericardiectomy, patients are typically monitored for any complications related to the procedure. The placement of chest tubes is crucial for effective drainage of the pericardial and pleural spaces, and these tubes are usually left in place until the output is minimal and the physician determines that the patient is stable. Patients may experience some discomfort and will be provided with pain management as needed. Follow-up care is essential to assess recovery and ensure that there are no complications such as infection or re-accumulation of fluid. The overall recovery time may vary based on the individual patient's health status and the extent of the surgery performed.
Short Descr THORACOSCOPY SURGICAL
Medium Descr THORACOSCOPY W/TOTAL PERICARDIECTOMY
Long Descr Thoracoscopy, surgical; with total pericardiectomy
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 49 - Other OR heart procedures
Date
Action
Notes
2012-01-01 Deleted Deleted Code
2011-01-01 Changed Short description changed.
1994-01-01 Added Code added.
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