Pulmonology Coding Alert

Answer: You should report both the E/M service and the thoracentesis. Although you may use the same diagnosis code for both, using a separate or different ICD-9 code when reporting each service is more accurate and could prove more beneficial. Using different diagnosis codes clearly notifies the carrier of the specific reason (medical necessity) for the procedure - for example, the thoracentesis.

You should also append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M visit.

For example, the claim may show 99233-25 (Subsequent hospital care, per day, for the evaluation and management of a patient & ) linked to 518.81 (Acute respiratory failure), and 32000* (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) linked to 511.9 (Unspecified pleural effusion).