# chest x-rays being bundled with thoracentesis



## chembree (Dec 2, 2011)

Can anyone give me any information about chest x-rays being bundled with thoracentesis? When is it appropriate to apply a 59?


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## donnajrichmond (Dec 2, 2011)

The immediate, initial chest x-ray after thoracentesis is bundled and should not be coded according to CMS.  Just like the immediate, initial chest x-ray after central venous catheter placement.  Others before or after for medically necessary reasons could be coded with -59. 
NCCI Policy Manual effective January 1, 2012 (though the edits are already in place):
9. When a central venous catheter is inserted, a chest
radiologic examination is usually performed to confirm the position of the catheter and absence of pneumothorax. Similarly when an emergency endotracheal intubation procedure (CPT code 31500), chest tube insertion procedure (e.g., CPT codes 32422, 32550, 32551), or insertion of a central flow directed catheter procedure (e.g., Swan Ganz)(CPT code 93503) is performed, a chest radiologic examination is usually performed to confirm the location and proper positioning of the tube or catheter. The chest radiologic examination is integral to the procedures, and a chest radiologic examination (e.g., CPT codes 71010, 71020) should not be reported separately.


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## armymomryan (Dec 7, 2011)

We bill for a diagnostic chest x-ray that is done prior to a thoracentesis, this is when you would use your 59, have been billing thorancentesis this way for years, never a problem but doc HAS to dictate that "following a diagnostic chest x-ray .................."


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## chembree (Dec 15, 2011)

armymomryan said:


> We bill for a diagnostic chest x-ray that is done prior to a thoracentesis, this is when you would use your 59, have been billing thorancentesis this way for years, never a problem but doc HAS to dictate that "following a diagnostic chest x-ray .................."



Thanks for the information... We have also coded thoracentesis for years but this is the first set of denials we have started seeing from our payors for the chest x-rays. It does make since to use the same logic as PICCs and chest. I appreciate everyone's help!


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