ED Coding and Reimbursement Alert

Question: Encounter notes state that the physician treats a patient suffering from exudative pleural effusion. The physician performs a level-five ED E/M, and inserts a needle in the patient's chest cavity to remove fluid. I reported 99285-25 and 32551 and received a denial -- what did I do wrong?

Minnesota Subscriber

Answer: You selected the wrong procedure code for your physician's actions. When you re-submit the claim, report the following:

• 32421 (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) for the needle insertion
• 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history; a comprehensive examination; and medical decision making of high complexity ...) for the E/M
• Modifier 25 (Significant, separately identifiable evaluation and management service on the by the same physician on the same day of the procedure or other service) appended to 99285 to show that the E/M and needle insertion were separate services
• 511.9 (Pleurisy; unspecified pleural effusion) appended to 32421 and 99285 to represent the effusion.

Explanation: Your physician performed thoracentesis with pneumothorax in this encounter; during this procedure, the provider inserts a small tube into the patient's chest with a needle to help remove fluid or air from the cavity.

The code you chose, 32551 (Tube thoracostomy, includes water seal [e.g. for abscess, hemothorax, empyema], when performed [separate procedure]), is for a more extensive procedure. Use 32551 when the physician must make an incision and insert a formal indwelling chest tube into the pleural cavity.

Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.