Pulmonology Coding Alert
Clear Confusion Over Reporting Thoracentesis with Diagnostic Ultrasound
Question: My physician likes to do a thoracentesis with ultrasound imaging guidance, and then she will do a diagnostic ultrasound to check for pneumothorax. She does this instead of ordering a chest x-ray after thoracentesis; she states it is faster and more accurate to check for a pneumothorax this way. My question is can I bill for a thoracentesis (32555) and U/S (76604-26) on same day, same session or are there other CPT® codes I need to look at.
However, you should note that your pulmonologist used ultrasound imaging guidance during the procedure and then again performed a diagnostic ultrasound. So, in addition to the imaging guidance in the initial procedure, she performed another totally independent procedure. Hence, you can report the initial thoracentesis procedure with the imaging guidance using the CPT® code 32555 and the additional diagnostic ultrasound to check for pneumothorax using 76604.
If your clinician only provided an interpretation for the ultrasound, you can report 76604 with the modifier 26 (Professional component) and the hospital that owns the equipment can claim for the technical component of the procedure by reporting the same code with the modifier TC (Technical component).
Reminder: There is no Correct Coding Initiative (CCI) edits for reporting 32555 with 76604. This will help ascertain that you can report these two procedural codes if the two procedures were performed in the same session on the same day. Be sure to document a full ultrasound report that will meet the requirements of the diagnostic study, which includes transverse, longitudinal, and oblique images of the chest wall with measurements of chest wall thickness, and imaging of the mediastinum.
Oregon Subscriber
Answer: When your physician performs thoracentesis with imaging guidance, you report the procedure with 32555 (Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance). If no imaging guidance is used during the procedure, you resort to using 32554 to report the procedure your clinician performed.
As 32555 includes “imaging guidance” in the descriptor, it is confusing whether or not to describe the ultrasound with 76604 (Ultrasound, chest [includes mediastinum], real time with image documentation) in the case scenario that you have provided.
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