Pulmonology Coding Alert

You Be the Coder:

Know the Difference Between Thoracostomy and Pleural Drainage

Published on Fri Sep 26, 2014

Question: Our pulmonologist performed a CT-guided right thoracostomy tube placement. We used maximum barrier precautions, prepped with Chlorhexidine solution, and used 1 percent Lidocaine. An 8 French pigtail catheter was passed through the chest wall into the pleural space using 1 stick trocar technique and was sewn in place after verifying position with another CT scan. The catheter was left in and fluid was draining into a bag. Our pulmonologistalso did a thoracentesis on same day. Can I code this as 32551? Are there any modifiers applicable?

Texas Subscriber

Answer: As per the description given by you above, it seems that provider is performing image guided thoracentesis. Code 32551 (Tube thoracostomy, includes connection to drainage system [e.g., water seal], when performed, open [separate procedure]) is not appropriate since this service requires a surgical cutdown; and 32555 (Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance)doesn’t fully represent the service provided. Report 32557 (Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance) since this service captures the service inits entirety, percutaneous pleural drainage by placement of an indwelling catheter (e.g., pigtail).

If a separate throcentesis was done earlier that day, prior to the need to place the catheter, it is possible to report both procedures with the documentation to support each distinct service. Modifier 59 is not required by Medicare as these services do not represent a Correct Coding Initiative (CCI) edit. However, ensure that the documentation identifies the need for each service in case the payer requests the documentation for review.

This code is not eligible for professional/technical split. You cannot append modifier 26 (Technical component). You should bill 32557 without any modifier.

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You Be the Coder:
Know the Difference Between Thoracostomy and Pleural Drainage
Question: Our pulmonologist performed a CT-guided right thoracostomy tube placement. We used maximum barrier precautions, prepped [...]

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