Wiki Insertion of Chest Tube

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maryv22

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Hello,
I am not sure how to code the insertion of a chest tube. Any feedback would be much appreciated!

Please note: Patient had an excisional biopsy of the caudate lobe in addition to insertion of a left chest tube.

The following is the only documentation related to the insertion of the chest tube:
Under general anesthesia, the patent's abdomen and left chest were prepped and draped. A #16 chest tube was inserted in the intercostal space using ultrasound guidance. 200 to 300 mL of turbid fluid were obtained and these were sent for culture and sensitivity, cell count, triglycerides, and cytology. The chest was then attached to a Pleur-Evac and a small amount of air was also seen to exit.

32550, 32551 or 32557
 
Good morning

Your note is pretty brief and the exact approach to placing the chest tube is not directly stated. Given the mention of the tube being placed under ultrasound guidance, I would conclude this was a percutaneous approach and report 32557 (due to the use of ultrasound guidance). CPT 32551 requires an open incision to place the tube which is not documented and 32550 is for a tunneled pleural cath (to report that code, you should see documentation of creating a subcutaneous tunnel and working towards a separate exit site). None of those details are supported in the note either. So again I would go with 32557 in this case due to the ultrasound guidance and the lack of an incision to place the tube which leads me to a percutaneous code. You may want to discuss this case with your physician as well if you have that opportunity and encourage him to specifically document percutaneous vs open approach in his chest tube notes for future cases as that will make it easier to choose the correct code.

I hope that helps :)

Have a great day
Kim
www.codingmastery.com
 
Hi Kim,

Thanks so much for your feedback. I agree with your reasoning and will definitely be educating the physician!

-Mary
 
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