Avoid Separate Imaging with Thoracentesis
Thoracentesis is a puncture made between the ribs into the pleural cavity to aspirate or remove accumulated fluid (pleural effusion) from the chest cavity. A needle attached to a syringe is introduced through the skin and chest wall until it penetrates the pleura.
For 2013, CPT® deleted 32421 and 32422, previously used to describe thoracentesis, and replaced them with two new codes:
● 32554 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance
● 32555 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance
The deleted codes previously allowed for separate reporting of image guidance (e.g., 76942, 77002, 77012), when performed. The new codes require that you report the procedure based on whether it is performed with imaging guidance.
Report 32554 when imaging guidance is not used; and report 32555 when the thoracentesis is performed with imaging guidance. CPT® includes a parenthetical note instructing you not to report imaging guidance separately with either 32554 or 32555. Imaging guidance includes any combination of fluoroscopy ultrasound, computed tomography, or magnetic resonance imaging.
Codes 32554 and 32555 describe chest drainage by a needle or catheter that is removed at the end of the procedure. New codes 32556 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance and 32557 Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance were created to report the percutaneous drainage of pleural fluid. Unlike thoracentesis, a tube or catheter is left in place to allow for continuous drainage. Once again, proper code assignment is determined based on whether the provider uses imaging guidance. Do not report imaging guidance separately when assigning 32556 or 32557.
Code 32551 Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure) represents open placement of a chest tube (e.g., for empyema, traumatic hemothorax, or pneumothorax), which always is done without imaging guidance.
The exception: Code 32550 Insertion of indwelling tunneled pleural catheter with cuff describes tunneled chest tube placement. Imaging guidance can be reported separately when this is performed. When imaging guidance has been provided, report 75989 Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation.