Pulmonology Coding Alert

Question: I submitted documentation with a line-itemized claim for three same-day services/procedures as follows:

--99233-25 (Hospital follow-up with modifier for same day of procedure)

--32002-50 (Thoracentesis w/cath with modifier for bilateral procedure at same operative session)

--32002 (Thoracentesis w/cath, no modifier).

Answer: You actually billed Medicare for four items. Reporting the thoracentesis (32002, Thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]) as you did using two lines and modifier 50 (Bilateral procedure) indicates the pulmonologist performed three taps, a medically unlikely event. If the physician only performed bilateral thoracentesis, which is more likely, you should have reported the bilateral services using a single line (a single unit), with modifier 50.

Action: Before you assume the pulmonologist performed three taps, check with the physician or documentation. If he indeed performed two taps, do not resubmit the claim because Medicare paid appropriately for the bilateral services.

If the physician performed three taps, resubmit the claim using modifier 59 (Distinct procedural service) on the third thoracentesis (32002) to indicate that the pulmonologist performed the tap at a separate session. Include a simple explanation of the separate sessions and attach copies of the separate operative reports showing the reason for the subsequent tap.