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Pulmonology Coding Alert

Reader Question:

Pleural Biopsy

Published on Sat Sep 01, 2001

Question: When a patient frequently has a large pleural effusion, and a pleural biopsy is performed at the same time fluid is drained, how should we code for both the pleural biopsy and the insertion of a 9-inch French catheter drain off the large collection of pleural fluid?

Michigan Subscriber
 
 Answer: Use 32002 (thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]), which addresses removing accumulated fluid or air from the pleural space by puncturing the space between the ribs, or 32020 (tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema] [separate procedure]), which represents insertion of a chest tube when a trocar or, commonly, an incision is used to puncture the space between the ribs into the pleural cavity.
 
According to the Correct Coding Initiative (CCI) edits, drainage of fluid from the pleural lining identified by either 32002 or 32020 is a component procedure of the pleural biopsy (32400). If the drainage is performed for a reason that is separate and distinct from the pleural biopsy, modifier -59 (distinct procedural service) can be attached to the CPT code identifying the appropriate drainage procedure, along with its separate and distinct ICD-9 code. This may allow for separate reimbursement of the pleural biopsy, if appropriate.

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