Pulmonology Coding Alert

Question: Our physician performed thoracentesis and inserted a tube for a pneumothorax. He also performed a tube thoracostomy for pleural effusion. I have heard that 32002 and 32020 cannot be reported together. Is that correct?

Tennessee Subscriber

Answer: Yes. The National Correct Coding Initiative bundles codes 32002 (Thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]) and 32020 (Tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema] [separate procedure]), so normally you cannot report these two codes together on the same day.
 
But if you can show that the procedures were distinct from and independent of each other (i.e., different session, patient encounter, different lobe of the lung, etc.), you would use modifier 59 (Distinct procedural service) on the second, lesser code. In this case, you would report 32020 and 32002-59.
 
Tip: Be prepared to provide the carrier with documentation substantiating your physician's justification for performing both procedures and why you think he should receive compensation for both procedures.
 
If the pulmonologist used fluoroscopy during these procedures, you may also be able to report that service. If a radiologist performed the fluoroscopy, the radiologist should report 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]). If the pulmonologist performed the fluoroscopy without the assistance of a radiologist, the pulmonologist should also report 76000.
 
Remember: The physician must issue a separate report focusing specifically on the fluoroscopy use, otherwise Medicare and other payers will not pay for the fluoroscopy.