General Surgery Coding Alert

Clear up old aspiration questions with new codes.

If your general surgeons provide chest tube services, you've got some changes coming your way that you won't want to miss. Get familiar with deleted and added codes to make sure you code your chest cases properly once CPT® updates become effective on Jan. 1, 2013.

Look at Lung Additions, Deletions, and Revisions, Too

Coding for removal of fluid from the chest cavity will look a little different in the New Year.

Deleted: Expect CPT® 2013 to delete these codes:

• 32420 -- Pneumocentesis, puncture of lung for aspiration
• 32421 -- Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent
• 32422 -- Thoracentesis with insertion of tube, includes water seal (e.g., for pneumothorax), when performed (separate procedure).

Added: In their place, you can expect to see four new codes:

• 32554 -- Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance
• 32555 -- ...with imaging guidance
• 32556 -- Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance
• 32557 -- ... with imaging guidance.

Revised: Code 32551 has some wording changes you should be sure to note. Text that will be deleted is crossed through and text that will be added is underlined: Tube thoracostomy, includes water seal connection to drainage system (e.g., for abscess, hemothorax, empyema water seal), when performed, open (separate procedure).

Matching Codes to Procedures Should Be Simpler

Good news: These changes should help clarify proper coding, says Lori Hendrix, CPC, CPC-I, CPC-H, CIRCC, PCS, FCS, senior project coordinator, compliance department, for Wellstar in Georgia.

In the past, this set of codes has "seemed to be somewhat of a challenge to coders," Hendrix says. A common area for confusion is "aspiration versus the drainage tube, and the new codes explain it better." Eliminating the pneumocentesis aspiration code will further reduce confusion, she says.

Aspiration vs. indwelling catheter: Based on the new code definitions, 32554 and 32555 apply to aspiration, and 32556 and 32557 apply when the physician places an indwelling catheter as part of the fluid removal service.

"An indwelling catheter is a small flexible tube placed with one end in the chest and the other end outside the skin. The catheter is left in place to allow for drainage," explains Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, audit manager for CHAN Healthcare in Vancouver, Wash.

Needle/catheter aspiration: Another typical troublemaker with the 2012 codes is how to code when the physician uses a catheter rather than a needle for aspiration. Codes 32554 and 32555 will help clarify this by specifying "needle or catheter."

Imaging guidance: The 2013 codes continue the CPT® trend of bundling imaging guidance into surgical procedure codes, Hendrix notes. Codes 32555 and 32557 specify "with imaging guidance."

The bottom line is that you should not report imaging separately for 32554-32557 in 2013. This marks a change from 2012 codes 32421 and 32422, which instruct you to report guidance separately (76942, 77002, or 77012).

Don't forget 32551 revision: In 2013, the definition of chest tube insertion code 32551 will specify that the service is an open procedure. Physicians perform tube thoracostomy to remove fluid from between the chest cavity and lungs.

Remember: Until the codes are official later this year, changes are still possible.