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Thoracostomy

  1. Default Thoracostomy
    Exam Training Packages
    32421
    32551
    75989-26
    76942-2659

    I have the above codes for the following procedure.Can we code 32551 for thoracostomy tube placement or can we code 32422 combining 32421 & 32551?

    Ultrasound Thoracentesis and Thoracostomy Tube Placement:

    66-year-old male status post
    laryngopharyngectomy, esophagectomy with gastric pull up with
    recurrent bilateral pleural effusions and episodes of desaturation
    during. Patient referred for image guided thoracentesis and
    thoracostomy tube placement.

    Initial US images demonstrated a large right-sided loculated
    pleural effusion.

    The posteriolateral left chest wall was then prepped and draped in
    the usual sterile fashion. After the administration of local
    anesthesia and under US guidance, access into the pleural effusion
    was obtained with an 18 gauge needle. Several cc's of
    serosanguinous fluid was aspirated. Samples were sent for culture
    and sensitivity, cytology, cell count and chemistry levels.
    An Amplatz wire was advanced through the needle and coiled within
    the collection. The needle was removed and serial dilatation of
    the tract was performed. An 8 French multi-sidehole pigtail
    drainage catheter was then advanced over the wire and positioned
    with its distal pigtail coiled within the pleural effusion.

    Approximately 300 cc of serosanguinous fluid was then aspirated.
    After which, repeat ultrasound images demonstrated marked residual
    fluid within the left pleural space.

    Repeat US images confirmed good positioning of the distal pigtail
    within the loculated pleural effusion and demonstrated residual
    fluid within the left pleural space.

    It was decided to maintain the thoracostomy tube for
    further drainage.

    The catheter was secured to the skin with 2 0 prolene suture. The
    catheter was flushed with 10 cc of normal saline and attached to
    Pleurovac drainage. A sterile dressing was applied over the skin
    entry site.
    Prabha CPC

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
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    Quote Originally Posted by prabha View Post
    32421
    32551
    75989-26
    76942-2659

    I have the above codes for the following procedure.Can we code 32551 for thoracostomy tube placement or can we code 32422 combining 32421 & 32551?

    Ultrasound Thoracentesis and Thoracostomy Tube Placement:

    66-year-old male status post
    laryngopharyngectomy, esophagectomy with gastric pull up with
    recurrent bilateral pleural effusions and episodes of desaturation
    during. Patient referred for image guided thoracentesis and
    thoracostomy tube placement.

    Initial US images demonstrated a large right-sided loculated
    pleural effusion.

    The posteriolateral left chest wall was then prepped and draped in
    the usual sterile fashion. After the administration of local
    anesthesia and under US guidance, access into the pleural effusion
    was obtained with an 18 gauge needle. Several cc's of
    serosanguinous fluid was aspirated. Samples were sent for culture
    and sensitivity, cytology, cell count and chemistry levels.
    An Amplatz wire was advanced through the needle and coiled within
    the collection. The needle was removed and serial dilatation of
    the tract was performed. An 8 French multi-sidehole pigtail
    drainage catheter was then advanced over the wire and positioned
    with its distal pigtail coiled within the pleural effusion.

    Approximately 300 cc of serosanguinous fluid was then aspirated.
    After which, repeat ultrasound images demonstrated marked residual
    fluid within the left pleural space.

    Repeat US images confirmed good positioning of the distal pigtail
    within the loculated pleural effusion and demonstrated residual
    fluid within the left pleural space.

    It was decided to maintain the thoracostomy tube for
    further drainage.

    The catheter was secured to the skin with 2 0 prolene suture. The
    catheter was flushed with 10 cc of normal saline and attached to
    Pleurovac drainage. A sterile dressing was applied over the skin
    entry site.

    The doc calls it a thorocostomy so I would give him the benefit of the doubt and code it:
    32551 (thoracostomy) this usually involves use of a trocar, not a needle.
    75898 (includes u/s guidance)

    I would not code both codes as there were not two procedures performed. The tube placement is a continuation of the procedure being performed, not a separate procedure.

    The other possible code(s) scenario is
    32422 (thoracentesis with tube) this usually involves a needle
    76942

    I hope this helps.
    Danny L. Peoples
    CIRCC,CPC

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