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MP 7.01.36 Thoracoscopic Laser Ablation of Emphysematous Pulmonary Bullae

Medical Policy
Section
Surgery
Original Policy Date
3/31/96
Last Review Status/Date
Reviewed with literature search/4:2003
Issue
4:2003
Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


Description

Thoracoscopic laser ablation of emphysematous pulmonary bullae involves the use of defocused carbon dioxide laser energy applied to bullous lesions through a thoracoscope in the pleural space. In cases of deep or extensive thick-walled bullous lesions, partial excision is sometimes performed through the thoracoscope with the use of an endoscopic electrocautery spatula.


Policy

Thoracoscopic laser ablation of pulmonary bullae is considered investigational.


Policy Guidelines

No applicable information


Benefit Application

BlueCard/National Account Issues

No applicable information.


Rationale

The original policy was based on a 1995 TEC Assessment that concluded that there were inadequate published data to permit scientific conclusions. (1) A literature search based on the MEDLINE database was performed for the period of 1995 to June 2003. No published literature regarding this procedure was identified, suggesting that this procedure is now largely obsolete.

References:

  1. TEC Assessments, 1995: Tab 33

 

Codes

Number

Description

CPT 

32655 

Thoracoscopy with excision placation of bullae, including any pleural procedure 

ICD-9 Procedure 

32.28 

Endoscopic excision or destruction of lesion or tissue of lung 

ICD-9 Diagnosis 

 

Investigational for all codes 

HCPCS 

No code 

Type of Service 

Surgery 

Place of Service 

Inpatient 


Index

Ablation, thoracoscopic laser, of emphysematous pulmonary bullae
Pulmonary bullae, thoracoscopic laser ablation
Thoracoscopic laser ablation of emphysematous pulmonary bullae


Policy History

Date

Action

Reason

03/31/96

Add to Surgery section

New policy

04/15/02

Replace policy

Policy reviewed without literature review; new review date only

12/17/03

Replace policy

Policy reviewed with literature search; policy statement unchanged.


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