Which Cpt Code Describes A Pneumonectomy

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The CPT Code for Pneumonectomy: A Clear Guide to 32310 and 32440

If you're a medical coder, billing specialist, or even a surgeon's office manager, you know the feeling. You have a complex procedure, a surgeon who documents in shorthand, and a form that demands a precise code. But one wrong number can mean the difference between a clean claim and a frustrating denial. Now, add a procedure like a pneumonectomy to the mix, and the stakes get higher. This isn't a simple biopsy; it's the surgical removal of an entire lung.

The question that often trips people up is straightforward but critical: Which CPT code describes a pneumonectomy? The answer isn't just one number; it's two, and knowing which one to use is essential for accurate billing. Let's cut through the confusion.

What Is a Pneumonectomy, Exactly?

Before we get to the codes, let's be clear on the procedure itself. So naturally, a pneumonectomy is the surgical removal of an entire lung. On top of that, it's not a partial resection where only a lobe or a segment is taken (those have their own codes). A pneumonectomy is exactly what it sounds like: the entire lung is removed.

This is a major thoracic surgery, typically performed for conditions like:

• Lung cancer that has not spread beyond the lung. In real terms, * Severe, irreparable trauma to the lung. * Chronic infections or diseases that have destroyed the lung's function, making it a dangerous liability.

The procedure can be performed as an open surgery (a large incision between the ribs) or, in some cases, minimally invasively using a video-assisted thoracoscopic surgery (VATS) approach. The approach matters for coding, as you'll see.

Why Getting the Code Right Matters More Than You Think

It might seem like just a five-digit number on a form, but the correct CPT code is the foundation of the entire reimbursement process. Using the wrong code can lead to:

• Claim Denials: The insurance company's system will reject the claim because the code doesn't match the procedure documented. This means delayed payment and more work for your staff.
• Underpayment: If you use a code for a less complex procedure (like a lobectomy, which removes only a lobe), you will be reimbursed at a lower rate than you deserve for a pneumonectomy.
• Compliance Issues: Inaccurate coding can be flagged during an audit, leading to penalties or repayment demands. Precision isn't just about money; it's about integrity in healthcare billing.

How It Works: The Two CPT Codes for Pneumonectomy

Here’s the core of the matter. There are two primary CPT codes for a pneumonectomy, and the choice depends entirely on whether the procedure is on the right or the left lung.

Code 32310: Pneumonectomy, Right or Left

This is your go-to code for a standard, unilateral pneumonectomy. So naturally, " The key word here is unilateral—meaning it applies whether the surgeon removes the right lung or the left lung. On top of that, the description in the CPT manual is simply "Pneumonectomy, right or left. The code itself does not differentiate between sides.

When to use 32310:

• For an open pneumonectomy (via thoracotomy).
• For a minimally invasive (VATS) pneumonectomy.

This code is used for the vast majority of pneumonectomies. The surgical approach doesn't change the code, which is a helpful simplification.

Code 32440: Pneumonectomy, Right or Left; with en-bloc resection of a portion of the pericardium

This is the more complex code, and it's used in specific, more extensive circumstances. The critical difference is the "en-bloc resection of a portion of the pericardium." The pericardium is the sac that surrounds the heart. If the cancer or disease is so close to the heart that the surgeon must also remove a piece of this protective sac along with the lung to get clear margins, the procedure moves from a standard pneumonectomy to a more radical one.

When to use 32440:

• When the surgeon removes the entire lung and a portion of the pericardium in one continuous specimen ("en-bloc").
• This is often necessary for centrally located tumors that involve the structures near the heart.

The documentation from the surgeon must explicitly state that the pericardium was resected. On the flip side, you cannot assume it or code for it based on the complexity of the case alone. The operative report is your best friend here.

Common Mistakes and What Most People Get Wrong

This is where the real-world challenges lie. Even experienced coders can stumble on these points.

1. Confusing Pneumonectomy with Lobectomy: This is the most frequent error. A lobectomy (removal of a lobe) is coded with 32505 (VATS) or 32390 (open). Using a lobectomy code for a pneumonectomy will result in significant underpayment. Always verify the extent of the resection in the operative report. Was it the "entire lung" or a "left upper lobe"?

2. Overlooking the Pericardium: The opposite mistake is also common. A coder might see a complex cancer case and automatically jump to 32440. That said, if the surgeon's notes do not mention a pericardial resection, you must use 32310. Adding a procedure that wasn't performed is a serious coding error.

3. Ignoring the Side (Laterality): While the code 32310 is for "right or left," you must still report the correct side using a separate ICD-10-CM diagnosis code. The CPT code is for the procedure, but the diagnosis codes explain why it was done and on which side. Laterality is a fundamental part of medical coding.

4. Missing the "Bilateral" Scenario: What if a patient needs both lungs removed? This is incredibly rare and usually staged (done at separate times). If it were done during the same operative session, you would likely report 32310 with the modifier -50 (Bilateral Procedure). Even so, this scenario is so unusual that it requires careful review of the documentation and payer policies.

Practical Tips for Accurate Coding: What Actually Works

Based on the common pitfalls, here is a simple, actionable workflow.

1. Start with the Operative Report: This is your source of truth. Don't rely on a billing summary or a quick note.
2. Identify the Key Sentence: Look for the line that describes the procedure. It will say something like, "The patient underwent a left pneumonectomy" or "A right pneumonectomy with resection of the pericardium was performed."
3. Ask Yourself Two Questions:
   • Was the entire lung removed? If no, you're not looking at a pneumonectomy code.
   • Was a portion of the pericardium removed with* the lung? If yes

Putting It All Together: A Step‑by‑Step Example

Let’s walk through a realistic operative report to see how the workflow plays out in practice.

For more on this topic, read our article on how to measure the diagonal of a rectangle or check out which item best completes the list.

Operative Report Excerpt*
“Under general anesthesia, a right posterolateral thoracotomy was performed. The right lung was mobilized and a right pneumonectomy was carried out. Here's the thing — the pericardium was partially resected to help with exposure. Worth adding: no other structures were removed. The patient tolerated the procedure well.

Applying the Workflow

1. Identify the Procedure – The report explicitly states “right pneumonectomy” and “partial pericardium resection.”
2. Ask the Two Core Questions
   • Was the entire lung removed?* Yes – this points to a pneumonectomy code.
   • Was a portion of the pericardium removed with the lung?* Yes – this adds the pericardial component.
3. Select the Base CPT Code – A pneumonectomy is coded with 32440 (Video‑assisted thoracoscopic surgery) or 32210 (open). The operative note mentions a thoracotomy, so the open code (32210) is appropriate.
4. Add the Pericardial Component – Because the pericardium was resected, we must add the appropriate add‑on code: 32440 already includes a pericardial resection when performed via VATS, but for an open approach the add‑on is 32440? Actually, the correct add‑on for pericardial resection is 32440? Let’s clarify: The CPT hierarchy for lung resections lists 32210 (open pneumonectomy) and 32440 (VATS pneumonectomy). The pericardial resection is bundled into the pneumonectomy codes when performed in the same operation; there is no separate add‑on for pericardium. That said, if the surgeon performed a partial* pericardial resection outside* the scope of the pneumonectomy (e.g., a separate pericardial window), you would use 32440? Actually, the correct add‑on for pericardial resection is 32440? Let’s check: The CPT manual shows 32440 (VATS pneumonectomy with pericardial resection) and 32210 (open pneumonectomy). For open, the pericardial resection is included. So the correct code is 32210 (open pneumonectomy) because the pericardium was resected as part of the procedure.
5. Document Laterality – The diagnosis code must reflect the right side, e.g., Z90.2 (Acquired absence of lung) or a malignancy code with laterality. For a pneumonectomy, the appropriate ICD‑10‑CM code is Z90.2 (Acquired absence of lung) with 0 for right side (or Z90.2 plus 0? Actually, ICD‑10‑CM uses laterality modifiers: Z90.2 (Acquired absence of lung) and 0 for right, 1 for left). So you would bill Z90.2 and 0.
6. Check for Bilateral Modifier – Only one lung was removed, so no bilateral modifier is needed.
7. Verify Payer Policies – Some payers require a separate line item for the pericardial resection if it is performed beyond the standard pneumonectomy exposure. Review the contract or call the payer’s coding department if there is any doubt.

Final Coded Set (Example)

Final Take‑away: Accuracy Pays Off

Accurate coding for lung resections hinges on three pillars:

1. Documentation – The operative report is the only source that can confirm the extent of lung removal, pericardial involvement, and laterality. Never guess; let the surgeon’s words dictate the code.
2. Verification – Cross‑check CPT hierarchy, understand bundling rules, and confirm whether pericardial resection is included or requires a separate add‑on.
3. Consistency – Align CPT selection with the diagnosis codes, ensuring laterality and medical necessity are clearly reflected.

When coders follow a disciplined workflow—starting with the operative report, asking the two core questions, and then validating each decision against the CPT manual and payer guidelines—they minimize claim denials, reduce audit risk, and ensure proper reimbursement for the complex work performed by thoracic surgeons.

In short, mastering the nuances of pneumonectomy versus lobectomy coding, recognizing pericardial resection, and correctly reporting laterality are not just technical exercises; they are essential practices that protect the financial health of the practice and uphold the

integrity of the coding process. By treating each operative note as a roadmap rather than a checklist, coders can translate surgical nuance into compliant, reimbursable claims.

Practical Tips for Daily Workflow

• Create a “Pneumonectomy Cheat Sheet” – Keep a one‑page reference that lists the key CPT codes (32100‑32225), their descriptors, and whether pericardial resection, diaphragm resection, or chest‑wall reconstruction is bundled. Highlight the add‑on codes that are separately reportable (e.g., +32505 for thoracoscopic wedge resection, +32506 for lobectomy with bronchoplasty) so you know when to look beyond the primary pneumonectomy code.
• put to work the CPT Assistant Archives – The American Medical Association periodically publishes clarifications on bundled services. A quick search for “pericardial resection pneumonectomy” often yields guidance that confirms whether the resection is considered part of the exposure or a distinct procedure.
• Use Modifier –22 Judiciously – If the operative report describes unusually extensive dissection, adhesiolysis, or reconstruction that goes beyond the typical pneumonectomy workload, consider appending modifier –22 (Increased Procedural Services). Attach a brief narrative explaining the extra work and be prepared to support it with operative details.
• Document Laterality Consistently – When the ICD‑10‑CM code requires a laterality character (e.g., Z90.2), verify that the same side is reflected in the CPT descriptor (right vs. left pneumonectomy). Mismatched laterality is a common trigger for claim denials.
• Maintain a Payer‑Specific Log – Some commercial carriers treat pericardial resection as a separate billable service when performed via a thoracoscopic approach, while others bundle it regardless of approach. A simple spreadsheet noting each payer’s stance, effective date, and contact person can save hours of back‑and‑forth during claim submission.
• Audit Your Own Work – Before finalizing a batch, run a internal audit using a checklist: (1) Does the CPT code match the extent of lung removal? (2) Is any additional resection (pericardial, diaphragmatic, chest‑wall) appropriately bundled or unbundled? (3) Is laterality present on both CPT and ICD‑10‑CM? (4) Are any modifiers justified and supported by documentation? Passing this checklist reduces the likelihood of post‑payment audits.

Staying Current

Thoracic surgery techniques evolve—robotic‑assisted pneumonectomies, hybrid approaches, and intraoperative imaging are becoming more common. g.Which means subscribing to specialty coding newsletters (e. , AHA’s Coding Clinic for ICD‑10‑CM/PCS* and the Society of Thoracic Surgeons* coding updates) ensures you capture new terminology and any emerging CPT add‑ons before they become standard practice.

Conclusion

Accurate coding for pneumonectomy—whether open or VATS—depends on a disciplined, evidence‑based approach that starts with the operative report, respects CPT bundling rules, aligns laterality with diagnosis codes, and validates each decision against payer policies. So by institutionalizing verification steps, maintaining quick‑reference tools, and staying abreast of guideline updates, coders not only safeguard reimbursement but also uphold the integrity of the clinical documentation that drives quality reporting and research. In the complex world of thoracic surgery coding, precision truly pays off.