CPT® Code 32905

Thoracoplasty, specifically the Schede type or extrapleural variant, is a surgical procedure aimed at addressing severe thoracic conditions such as chronic thoracic empyema and pulmonary tuberculosis. This operation involves the strategic removal of a number of ribs, which serves to eliminate the skeletal support on one side of the chest, leading to the intentional collapse of the chest wall. The primary goal of this procedure is to obliterate the pleural space, thereby preventing the accumulation of fluid or infection that can occur in conditions like empyema. The procedure can be performed in a single stage or as a multi-stage operation, depending on the severity of the condition and the specific needs of the patient. The standard surgical approach for thoracoplasty is typically through a parascapular incision, which allows for adequate access to the thoracic cavity. During the operation, the surgeon performs a subperiosteal resection of multiple ribs, commonly targeting the first through the seventh ribs, although up to eleven ribs may be removed if necessary. This extensive resection involves sectioning the intercostal muscles and identifying and cutting the intercostal nerve to facilitate the procedure. An extensive skin and muscle flap is then raised, allowing the lung to be dissected away from the chest wall. To assist in maintaining the collapse of the chest wall, the costotransverse ligament may be divided, enabling the scapula and extracostal musculature to drop into the newly created space. Following the rib resection and dissection, the extracostal muscle and skin are partially closed over gauze packing, which promotes the formation of fresh granulation tissue. This granulation tissue is crucial as it will eventually fill and obliterate the cavitary space or empyema, leading to improved patient outcomes. It is important to note that in CPT® Code 32905, the thoracoplasty procedure does not involve the closure of a bronchopleural fistula, which is a separate consideration addressed in CPT® Code 32906.