CPT® Code 32906

The procedure described by CPT® Code 32906 refers to a thoracoplasty performed using the Schede type or extrapleural technique, specifically with the closure of a bronchopleural fistula. Thoracoplasty is a surgical intervention that involves the removal of one or more ribs, which serves to eliminate the skeletal support on one side of the chest, leading to the collapse of the chest wall. This surgical approach is typically indicated for patients suffering from chronic thoracic empyema or pulmonary tuberculosis, as it aims to obliterate the pleural space that may be contributing to these conditions. The procedure can be executed in a single stage or as a multi-stage operation, depending on the complexity of the case and the extent of the disease. The standard surgical approach for this procedure is through a parascapular incision, which allows the surgeon access to the thoracic cavity. During the operation, a subperiosteal resection of multiple ribs is performed, commonly involving the removal of the first through the seventh ribs, although up to eleven ribs may be resected if necessary. The intercostal muscles are sectioned to facilitate access, and the intercostal nerve is identified and cut to prevent pain and discomfort post-surgery. An extensive skin and muscle flap is then raised, and the lung is carefully dissected away from the chest wall. To assist in maintaining the collapse of the pleural space, the costotransverse ligament may be divided, allowing the scapula and surrounding musculature to drop into the space. The procedure concludes with the partial closure of the extracostal muscle and skin over gauze packing, which promotes the formation of fresh granulation tissue that will eventually obliterate the empyema or cavitary space. In contrast to CPT® Code 32905, which involves thoracoplasty without the closure of a bronchopleural fistula, CPT® Code 32906 specifically includes the closure of such a fistula. This involves debriding the fistula of any necrotic and inflammatory material, followed by closure using sutures or staples, which may be reinforced with a local flap of pleura, pericardium, or mediastinal fatty tissue. In some cases, the repair may necessitate the creation of a vascularized muscle flap or omental flap to adequately cover the bronchial leak site.